人工髓核置换术治疗腰椎问盘突出症的近期临床疗效观察

目的探讨人工髓核置换术治疗腰椎间盘突出症的近期临床应用效果。方法自2004年3月~2004年5月,笔者采用人工髓核置换术治疗腰椎间盘突出症25例,23例经标准后侧入路单枚PDN植入,1例经横突间入路单枚PDN植入,1例经腹膜后入路单枚PDN植入。术后随访6~18个月。结果1例术后1周出现剧烈腰痛,摄片示PDN位置好,给予卧床、镇痛、脱水治疗后缓解;1例术后4周出现腰腿痛,摄片示PDN部分移位于椎管,二次手术取出PDN行融合术后症状缓解;1例术后1个月PDN部分塌陷入椎体内,偶有腰痛,对症治疗,症状缓解。X线片复查手术后椎间隙高度平均增加3.34mm。腰椎各方活动基本正常,根据Oswestry下腰痛和功能不利评分,临床成功率84%,无感染等并发症。结论人工髓核置换术治疗腰椎间盘突出症在改善症状的同时能够增加椎间高度,保留腰椎的正常运动功能,为腰椎间盘突出症的手术治疗提供了一种新方法。     

髓核成形术治疗腰腿痛患者的选择(附45例临床初步报告)

目的:探讨髓核成形术治疗腰腿痛患者的最佳适应证。方法:应用髓核成形术治疗45例腰腿痛患者,男26例,女19例,平均年龄32岁(18~46岁),病程平均2年(5个月~4年),其中腰痛伴有下肢放射痛40例。手术前先进行椎间盘造影,然后行髓核成形术治疗,比较手术前后疼痛症状并进行疗效评定。结果:术后随访3~20个月,平均12个月。优良率为80%(36例);腰痛伴有下肢放射痛者有效率为85%;椎间盘造影阳性者有效率为92%。无效8例,术后加重1例。结论:在下列情况下应用髓核成形术治疗腰腿痛患者将提高临床的有效率:(1)腰痛伴有下肢放射痛症状的患者;(2)影像学上表现为侧方小的椎间盘突出,以神经根刺激症状为主要症状者;(3)椎间盘造影阳性的患者。     

人工髓核置换术治疗腰椎间盘突出症

目的介绍人工髓核置换手术治疗腰椎间盘突出症的方法及短期疗效观察结果。方法对2002年2月～2003年5月接受人工髓核置换术的28例患者，进行短期随访，时间6个月～1年9个月，平均1年2个月，通过其自觉症状变化及X线片情况，初步判断治疗效果。结果所有病人复查X线片，术后椎间高度不同程度恢复，未见有髓核位置的明显变化，也未发现有终板塌陷的现象。患者下腰椎活动度及腰痛均有改善。结论腰椎间盘人工髓核置换术是治疗腰椎间盘突出症的有效方法，是脊柱解剖与功能重建的一种趋势，术后合理的康复治疗有助于患者的康复，减少并发症的发生。     

人工髓核置换术治疗腰椎间盘病变的中远期随访结果

目的 探讨人工髓核置换术治疗腰椎间盘病变的中远期疗效和影响因素.方法 回顾性分析2002年3月至2003年10月采用人工髓核置换术治疗的34例腰椎间盘病变患者的临床资料.其中椎间盘源性腰痛20例,腰椎间盘突出症14例;随访时间48～66个月,平均52.6个月.采用Oswestry功能障碍指数(ODI)评分和疼痛视觉模拟评分法(VAS)评估患者术后改善情况和中远期功能.术前ODI评分平均58.4%,VAS评分平均7.4分.对放射学资料进行手术节段活动度、手术节段椎间隙高度变化对比研究.结果 术后早期腰痛及下肢痛症状明显缓解,术后12个月ODI评分平均18.2%,VAS评分平均1.8分,椎间隙高度较术前平均增加17.6%,手术节段活动度平均为9.2°.末次随访时,患者下肢放射性疼痛缓解满意,18例患者下腰痛逐渐加重,ODI评分平均为31.2%,VAS评分平均为3.1分.椎间隙高度较术前平均下降13.5%,手术节段活动度平均为6.8°,植入物移位发生率73.5%(25/34),软骨终板退变损伤发生率64.7%(22/34).结论 人工髓核置换术尚不能达到长期维持手术节段椎间隙高度的目的 ,术后手术节段活动度逐渐减少,下腰痛逐渐加重影响其中远期疗效,明确术前诊断和严格手术指征非常重要.     

髓核游离至硬膜囊背侧致截瘫的腰椎间盘突出症1例

腰椎间盘突出纤维环破裂髓核游离至硬膜囊背侧极为少见[1,2],国内郝永宏等收治1 126例腰椎间盘突出症患者,其中腰椎间盘突出纤维环破裂髓核游离至硬膜囊背侧者仅12例,占同期腰椎间盘突出症的1·1%,患者均未发生截瘫[3]。近期我们收治1例髓核游离至硬膜囊背侧引起截瘫的腰椎间盘突出症患者,报告如下。患者,男,55岁。以“腰痛伴双下肢麻木无力1月余”主诉入院。1个月前感腰痛向右下肢放射,在外院诊断为椎间盘突出症,行腰椎管封闭及牵引治疗术,术后腰痛及右下肢放射痛好转,但次日感腰痛伴双下肢麻木无力,无大小便失禁,双下肢麻木无力呈进行性加…     

小切口椎板间开窗髓核摘除术治疗腰椎间盘突出症临床分析

目的：通过评价小切口椎板间开窗髓核摘除术治疗腰椎间盘突出症的手术疗效,探讨其手术的优缺点及注意事项。方法：对96例腰椎间盘突出症患者采用小切口椎板间开窗髓核摘除术进行治疗,其中男48例,女48例;年龄16～75岁,平均46.4岁;病程1个月～30年,平均5年。采用日本骨科学会（JOA）下腰痛评分标准评价其手术后疗效。结果：所有患者均获随访,时间6个月～3.5年,平均1.2年。采用JOA下腰痛评分标准：优34例,良55例,中7例,优良率为92.71%,平均改善率为54.53%。结论：小切口椎板间开窗髓核摘除术能够取得良好的疗效,对腰椎生理结构破坏较小,发生术后腰椎不稳及腰椎术后失败综合征的可能性较低,是目前较好的腰椎间盘突出症手术治疗方式之一。     

射频消融髓核成形术治疗椎间盘源性腰痛疗效分析

目的 探讨经皮射频消融髓核成形术治疗椎间盘源性腰痛的疗效和安全性.方法 对45例椎间盘源性腰痛患者作射频消融髓核成形术治疗.结果 术后平均随访10.5个月,术前腰痛VAS评分平均为(7.5±0.45)分,术后1周、1个月和最后一次随访分别为(3.6±0.23)分、(3.1±0.55)分和(3.3±0.34)分.包容性腰椎间盘突出症的患者术后下肢放射痛均有不同程度的减轻,无相关并发症.结论 对于椎间盘源性腰痛,射频消融髓核成形术是一种安全和有效的微创手术;但对于神经根性疼痛的缓解效果不佳.     

腰椎间盘突出症的综合疗法

1982年5月～1994年6月，应用牵引下按抖腰及旋转扳拿手法配合中药内取治疗腰椎间盘突出症186例，取得较好疗效，总结如下。临床资料186例中男122例，女64例；年龄18岁～65岁；病程7天～8年；L3。突出者5例；L。5突出者105例，LSSI突出者70例；LS一民双节段突出者6例；有明显外伤史145例；大部分病例为长期体力劳动后出现腰酸痛、而后渐放射于下肢，仅腰能臀部疼痛者12例。腰痛伴单侧下肢放射痛，痛性歧行、腰椎侧弯、活动受限156例，腰痛伴双下肢痛4例，单纯下肢放射痛14例；推旁压痛放射痛175例；直腿抬高并加强试验阳性178例，依据临…     

人工髓核置换术治疗腰椎间盘突出症

目的 介绍人工髓核置换手术治疗腰椎间盘突出症的方法及短期疗效观察结果。方法 对2002年2月~2003年5月接受人工髓核置换术的28例患者,进行短期随访,时间6个月~1年9个月,平均1年2个月,通过其自觉症状变化及X线片情况,初步判断治疗效果。结果所有病人复查X线片,术后椎间高度不同程度恢复,未见有髓核位置的明显变化,也未发现有终板塌陷的现象。患者下腰椎活动度及腰痛均有改善。结论 腰椎间盘人工髓核置换术是治疗腰椎间盘突出症的有效方法,是脊柱解剖与功能重建的一种趋势,术后合理的康复治疗有助于患者的康复,减少并发症的发生。     

腰椎间盘突出症术后失稳的手术治疗

目的：探讨椎间植骨融合、椎弓根内固定系统在腰椎间盘切除术后脊柱失稳再手术中的应用和临床效果。方法：回顾总结1997年5月～2002年8月收治的采用后路椎管减压、腰椎间盘髓核摘除治疗爱椎间盘突出症导致的腰椎失稳再手术病例23例，男14例，女9例；年龄28～64岁，平48．5岁。再手术距初次手术时间2～10年，平均5年8个月。病程6个月～3年，平均1年6个月。单节段病变17例，双节段病变6例。所有患者初次手术行椎间盘切除术，根据手术后症状和影像学检查评估脊柱失稳程度以确定再手术治疗。结果：手术时间120～210min，平均180min；术中出血550～800ml，平均650ml；术后随访1～6．4年，平均3．6年。疗效应用MPQ问卷和下腰痛及功能不利评分评定，临床成功率86.9%，患者满意率82．6％。螺钉断裂2枚，松动1枚。5例出现神经根刺激症状，23周后恢复。3例硬膜撕裂。3例植骨未融合，其中2例行后外侧融合术。结论：腰椎间盘突出术后脊柱失稳再手术时应行腰椎融合术，同时应用内固定，促进植骨融合并以维持椎间隙稳定，疗效满意，无严重并发症发生。     

腰椎间盘人工髓核假体置换术临床应用初步报告

目的评价人工髓核假体(prostheticdiscnucleus,PDN)置换术治疗腰椎间盘突出症的近期效果。方法2002年3～6月,共施行PDN置换术20例,男13例,女7例,平均年龄38.4岁;均为单节段腰椎间盘突出症,其中L4-5 17例,L5S1 3例;病程6个月～10年,平均26.7个月。均采用单枚PDN置入,PR725型15例,PR925型1例,PR525型1例,PW725型2例,PW525型1例。结果所有患者术后临床症状均消失,运动功能明显改善。17例获得1～3个月随访,椎间隙高度较术前平均增加15.8%,差异有非常显著性意义(t=5.84,P<0.01), 无早期假体移位发生。术后早期并发症主要包括一过性腰部酸痛和低热。结论PDN置换术能有效恢复退行性椎间盘病变患者的椎间盘高度,近期效果肯定,多数国人适合置入单枚PR725型PDN。     

Prosthetic disc nucleus (PDN) replacement for lumbar disc herniation: preliminary report with six months' follow-up

A clinical follow-up study was performed to evaluate lumbar disc nucleus replacement clinically and functionally. The objective was to assess the clinical efficacy of the prosthetic disc nucleus (PDN) for treatment of lumbar disc herniation. The PDN was designed to treat patients suffering from disc herniation and/or degeneration. Clinical trials for PDN were first conducted in 1996, and the results showed that the PDN device was effective in most of the patients who were implanted. These studies had been carried out with patients who were implanted with a pair of the devices. The main complication was device migration. Therefore, a follow-up study based on a single PDN device implantation was designed to evaluate its clinical result. Forty-five patients with lumbar disc herniation were implanted with one PDN device from March 2002 to December 2002. Thirty (66.7%) patients came to the clinical, functional, and radiographic 6-month follow-up examinations. Independent analysis was performed by careful review of the charts, operative notes, preoperative and postoperative radiographs, magnetic resonance images, and follow-up records of all patients. After implantation, significant proportions of patients experienced pain relief. Improvements were noted in pain intensity, walking distance, lumbar mobility, neurologic weakness, Oswestry and Prolo scores, and intervertebral disc height. No difference in work status after PDN implantation could be detected. Compared with the preoperative height, the intervertebral disc had gained 19.7% (P < 0.001). Device migration, failure, and dislocation were not noticed in any patient. A few patients had minor complications such as transient low-grade fever. Clinically, a single PDN is preferred and can effectively increase the height of the intervertebral disc in patients with lumbar disc herniation. However, long-term follow-up of PDN implantation needs to be studied.     

Artificial nucleus replacement: surgical and clinical experience

Objective: To assess long‐term clinical results of prosthetic disc nucleus (PDN) replacement for the treatment of lumbar disc herniation. Methods: Seventy‐two patients with lumbar disc herniation were implanted with a single PDN device from March 2002 to December 2003. Fifty‐eight (80.6%) patients attended clinical, functional, and radiographic follow‐up examinations for more than 48 months. Independent analysis was performed by careful review of the interviews, operative reports, preoperative and postoperative radiographs, and computed tomography scans or magnetic resonance imaging (MRI). Results: After implantation, a significant proportion of patients experienced pain relief. Improvements were noted in pain intensity, walking distance, neurological weakness, Oswestry and Prolo scores, intervertebral disc height and lumbar mobility. Intervertebral disc height was not well maintained, compared with the preoperative height it decreased 18% (P < 0.001). Several complications were associated with the implantation of PDN, including transient low‐back pain, implant dislocation, malposition of the implant, damage to the end plates and subsidence of implant. Conclusion: The clinical data show that PDN is preferred and can effectively increase the range of lumbar motion in patients with lumbar disc herniation. However, this study only represents cases in our centre.     

Failure of the Wallis interspinous implant to lower the incidence of recurrent lumbar disc herniations in patients undergoing primary disc excision

BACKGROUND: Ipsilateral recurrent disc herniation after lumbar discectomy is a significant problem in the management of lumbar disc disease and may necessitate repeat surgical intervention. A population-based study in Finland found that about 14% of all primary lumbar discectomies required additional surgical interventions. Interspinous devices, which have been shown to unload the posterior anulus, may reduce the occurrence of recurrent herniations. We report our short-term experience with the use of the Wallis device in the management of patients with lumbar disc herniation undergoing primary disc excision. PATIENTS AND METHODS: Thirty-seven consecutive patients (23 males and 14 females, average age 36 y) underwent primary lumbar disc excision followed by fixation of the segment with the Wallis implant during a period of 1 year. Indications for implanting the Wallis device were a voluminous disc herniation and preservation of at least 50% of disc space height. Surgery was performed at level L4-5 in most patients. Average follow-up after surgery was 16 months (range 12 to 24). The last 14 patients were also evaluated by the preoperative and postoperative Oswestry Disability Index (ODI) questionnaire, the SF-36 survey, and by a visual analog scale (VAS) for back and leg pain. RESULTS: The average ODI dropped from 43 to 12.7. The average VAS for back pain dropped from 6.6 to1.4 and the average Vas for leg pain dropped from 8.2 to 1.5. Five patients (4 males and 1 female) with relapsing leg pain were diagnosed by contrast-enhanced magnetic resonance imaging as suffering from recurrent herniation (5/37, 13%). All reherniations occurred at level L4-5 level between 1 and 9 months after the index surgery. Two of the 5 patients subsequently underwent additional discectomy and fusion. SUMMARY: The current Wallis implant is probably incapable of reducing the incidence of recurrent herniations, but it still may be useful in patients with discogenic back pain due to early degenerative disc disease.     

手术治疗腰椎间盘突出症的长期疗效及其影响因素

目的:评估腰椎间盘突出症手术治疗的长期疗效,探讨影响手术长期疗效的相关因素。方法:回顾性分析1996年2月～2002年12月在我院采用单纯开窗减压髓核摘除术治疗的125例单节段腰椎间盘突出症患者,记录患者性别、年龄、体重指数(body mass index,BMI)、病程、临床表现、体征、手术减压时椎间盘的突出类型和末次随访时复发性椎间盘突出症的例数。分别记录术前和末次随访时Oswestry伤残指数(Oswestry Disability Index,ODI)及腰痛/下肢根性痛的视觉模拟评分(visual analog scale,VAS)。根据Stauffer-Coventry′s(SC)疗效评定标准评价患者总体疗效。单因素分析患者术前与末次随访时的VAS以及ODI。患者总体疗效作为结果变量,单因素分析年龄、性别、BMI、吸烟、腰扭伤史、病程、术前腰痛VAS评分、术前下肢痛VAS评分、术前ODI、直腿抬高试验(straight-leg raise test,SLR)、肌力、感觉、椎间盘突出节段和类型等14项指标与疗效的关系。用非条件Logistic全回归分析和逐步回归分析来研究结果变量与术前各种指标的关系。结果:随访84～123个月,平均109个月,患者总体疗效优占32%,良占35.2%,可占23.2%,差占9.6%,复发率为8%。术前ODI为(72.23±25.72)%,末次随访时为(15.64±17.52)%,与术前比较有显著性差异(P<0.05)。腰痛VAS评分术前为5.44±3.43分,末次随访时为2.12±2.32分;下肢痛VAS评分术前为7.34±3.72分,末次随访时为1.42±2.74分;末次随访时与术前比较均有显著性差异(P<0.05)。全回归分析发现腰扭伤史、感觉减退是总体疗效不佳的相关因素,而非包含型突出类型是总体疗效佳的相关因素。逐步回归分析发现有4个有统计学意义的相关因素,其比值比(OR)及95%可信区间分别为:腰扭伤史(OR=6.50;95%CI 2.21-19.10)、吸烟(OR=4.48;95%CI 1.51-13.34)、感觉(OR=9.01;95%CI 1.75-46.46)、突出类型(OR=0.027;95%CI 0.005-0.145)。结论:手术治疗可以明显改善腰椎间盘突出症患者的腰痛、下肢痛和ODI。腰扭伤史、吸烟史、术前感觉和突出类型是影响腰椎间盘突出症手术长期疗效的相关因素。     

改良腰椎板截骨回植治疗失稳性腰椎间盘突出症

目的：评价改良腰椎板截骨回植在失稳性腰椎间盘突出症中的疗效。方法：2009年3月至2011年8月对63例失稳性腰椎间盘突出症的患者行髓核摘除＋椎间融合＋椎弓根螺钉内固定＋改良腰椎板截骨回植手术,男33例,女30例;年龄22～68岁,平均48．4岁;病程3个月～13年,平均38．8个月。患者均有不同程度的腰腿疼痛,x线片、CT及MR检查诊断为失稳性腰椎间盘突出症。观测手术前后ODI和JOA评分、并发症发生率、影像学回植椎板愈合率及腰腿痛复发率。结果：62例患者切口I期愈合,1例11期愈合,无下肢深静脉血栓及椎间隙感染等并发症出现。61倒获1年或以上随访,平均随访时间33个月。术中神经损伤发生2例,硬膜囊损伤发生1例;术后1年回植椎板愈合58例：腰痛复发4例,腿痛复发1例。术后2周、6、12个月的ODI及JOA评分显著优于术前（P〈0．05）。结论：改良椎板截骨回植术治疗失稳性腰椎间盘突出症具有较低的术中神经硬膜囊损伤率和腰腿痛复发率、较高的椎板愈合率和较好的临床评分,是一种安全、有效的新方法,为临床失稳性腰椎间盘突出症手术开辟了一种新的术式。     

Mid- to long-term outcome of disc excision in adolescent disc herniation.

BACKGROUND CONTEXT: Adolescent disc herniation and its surgical treatment have been the subjects of many published clinical series. The majority of these series were heterogeneous; the number of adolescent patients (12-17 years) as opposed to young adults (18-20 years) was generally small and the length of follow-up varied greatly. Although the short-term outcome of disc excision in adolescents was mostly favorable, their long-term outcome is unknown. OBJECTIVES: To evaluate the mid- and long-term results of discectomy in patients younger than 17 years of age. STUDY DESIGN: Retrospective examination of a series of adolescent patients under the age of 17 years who underwent surgery for lumbar intervertebral disc herniation. PATIENT SAMPLE: The medical records of 26 patients (15 males, 11 females, 12-17 years old [average 14.6]) who were operated for lumbar intervertebral disc herniation in three spine centers between 1984 and 2002 were reviewed. These subjects represented the total number of patients meeting the criteria of adolescents undergoing discectomy for lumbar disc herniation in these institutions during the study period. All patients were located and contacted by an independent observer not involved in the care of these patients. Low back pain associated with leg pain was the main clinical symptom in 20 patients (77%), leg pain in 4 (15%), and back pain in 2 (8%). They all underwent posterior disc excision: 23 (88%) patients had one level discectomy, and 3 (12%) had simultaneous discectomy at two levels. The L4-L5 interspace was involved 19 times, and the L5-S1 interspace 10 times. Slipped vertebral apophysis was diagnosed in 4 patients (15%). Twelve of the 26 patients (46%) had a first-degree relative with a history of lumbar disc herniation. OUTCOME MEASURES: Telephone interviews provided follow-up data for 26 patients. Results were classified as excellent, good, moderate, or poor according to current symptom status, the need for additional surgery, the Oswestry Disability Index, and back and leg pain scores. RESULTS: The average time from surgery to follow-up was 8.9 years (range 3-21 years). At follow-up, the clinical results were excellent in 13 patients (50%), good in 4 (15%), moderate in 8 (31%), and poor in 1 (4%). Four subjects (15%) underwent a subsequent disc excision in the lumbar region, and one of them later underwent fusion. CONCLUSIONS: Discectomy provides satisfactory clinical results in young patients with disc herniation. The rate of reintervention (15%) is comparable to that in adults, indicating that discectomy for young patients should be approached similarly to that in adults.     

经皮内镜椎间孔入路手术治疗老年腰椎间盘突出症的临床分析

目的探讨经皮内镜椎间孔入路手术治疗老年腰椎间盘突出症的适应证,分析手术技术及疗效。 方法回顾性收集辽宁省抚顺市中心医院骨科2016年1月至2018年6月,采用经皮内镜椎间孔入路手术治疗单责任节段老年腰椎间盘突出症患者67例,男性24例,女性43例,年龄60~87岁,平均年龄（68±7）岁。责任节段：L_3~4间盘突出11例,L_4~5间盘突出42例,L₅~S₁间盘突出14例。病程0.5~36个月。采用疼痛视觉模拟评分（VAS）、Oswestry功能障碍指数（ODI）、改良MacNab评价临床疗效。 结果本组均顺利完成手术,手术时间60~150 min,平均（105±18）min。随访6~12个月,平均（7.5±1.6）个月。除1例症状未改善外,其余66例患者腰腿痛症状及神经功能障碍均有不同程度的缓解。术前患者腰痛VAS评分为（3.5±1.2）分,腿痛VAS评分为（8.0±1.1）分,ODI指数为（70±18）,术后6~12个月随访时腰痛VAS评分为（1.7±0.9）分,腿痛VAS评分为（1.0±1.6）分,ODI指数为（17±10）,差异均有统计学意义（t=13.718,t=30.973,t=23.059,均P=0.000）。按照改良MacNab评价标准,优42例,良18例,可5例,差2例,优良率89.55%。无硬膜撕裂、神经根损伤和感染,术中出现颈痛3例,术后出现下肢一过性麻木疼痛5例,下肢疼痛持续残留2例,出现对侧下肢疼痛1例,腰痛明显加重2例,复发1例。 结论具备熟练的椎间孔镜技术,掌握好手术适应证,明确责任阶段,采用经皮内镜椎间孔入路手术治疗老年腰椎间盘突出症可取得良好的近期效果。