介入治疗颈椎间盘突出症的临床观察及护理

目的：探讨射频、胶原酶及三氧联合应用治疗颈椎间盘突出症的疗效及护理。方法对46例颈椎间盘突出症患者，在C型臂X线引导下行突出椎间盘穿刺，穿刺成功后盘内予70℃、120 s ，80℃、120 s ，90℃、60 s分别射频热凝，盘内注入胶原酶400 U ，在盘外注入三氧5 ml ，浓度为20μg/ml。术后1个月、3个月、6个月随访症状的改善情况及生活质量。结果治疗后1个月、3个月、6个月优良率分别为91．3％（42/46例）、95．6％（44/46例）、95．6％（44/46例），差异无显著意义，总有效率为95．6％（44/46例）。结论射频、胶原酶及三氧联合应用治疗颈椎间盘突出症是一种操作方便、创伤小、安全有效的治疗方法，精心的护理是此项技术成功实施的重要保障。     

椎旁与侧隐窝注射在腰椎间盘突出症治疗中的应用比较

目的比较椎旁与侧隐窝注射在腰椎间盘突出症治疗中的疗效及安全性。方法选择腰椎间盘突出症患者200例,随机分为经椎旁注射组(Ⅰ组,n=100)和经侧隐窝注射组(Ⅱ组,n=100),用药均为消炎镇痛复合液。两组均结合针灸推拿等中医疗法,观察两组治疗效果、安全性以及不良反应。结果Ⅰ组的有效率和优良率分别为90%和77%,Ⅱ组的有效率和优良率分别为92%和78%。两组的治疗效果比较无显著性差异。Ⅰ组的神经激惹征发生率更少。结论两组均可应用于腰椎间盘突出症的治疗,并均可获得满意疗效,但经椎旁较经侧隐窝入路操作相对简单、容易掌握,且不良反应更少。     

CT与MRI用于极外侧型腰椎间盘突出诊断价值比较分析

目的研究并比较CT与MRI对于诊断极外侧型腰椎间盘突出的准确性。方法从2011年1月到2013年3月,选取我院被诊断为极外侧型腰椎间盘突的病患共82例,作为研究对象。以数字法随机分成观察组(41例)和对照组(41例)。观察组病患通过MRI确定极外侧型腰椎间盘突出的阳性检出率;对照组病患通过CT确定极外侧型腰椎间盘突出的阳性检出率。对比两组极外侧型腰椎间盘突出的阳性检出率。结果观察组I度检出率为36.59%(15/41),阳性检出率为97.56%(40/41),均显著高于对照组的21.95%(9/41),75.61%(31/41)。差异均有统计学意义(均P0.05)。观察组漏诊率为2.44%(1/41)显著少于对照组的24.39%(10/41)。差异均有统计学意义(均P0.05)。结论 MRI对极外侧型腰椎间盘突出的检出率显著,并且MRI可明显减低漏诊率,具有积极意义,值得临床推荐。     

Bilateral lymphangiomatous polyps of the palatine tonsils

Lymphangiomatous polyps of the tonsils are rare with less than 30 cases reported in the literature. All have been unilateral. We report a case of a child with bilateral lymphangiomatous polyps of the palatine tonsils that was suspected on preoperative examination as opposed to an incidental postoperative histologic finding. These findings were also correlated with a further imaging study to establish this entity as a localized rather than a generalized histologic phenomenon.     

Unusual case of camptocormia triggered by lumbar-disc herniation

A 21-year-old male patient with low back pain and marked forward bending was presented. The exaggerated lumbar flexion was preventing him to stand in erect posture but disappeared while lying. The symptoms had begun after he had lifted a heavy object. Straight-leg-raising test could not be performed properly because of the exaggerated pain. The light-touch sense was decreased on L5 and S1 dermatomes. There was no loss of muscle strength. The deep-tendon reflexes were normal. Plain graph showed mild narrowing in the L4–5 and L5–S1 intervertebral spaces. Lumbar magnetic resonance imaging revealed disc protrusions in L4–5 and L5–S1 levels. During his stay in the department, the patient was given tizanidine and tramadol, and physical therapy was performed. A paravertebral intramuscular injection with lidocaine was applied. Moreover, the patient was referred to psychiatrist for evaluation regarding his medical history of conversive seizures and possible efforts for secondary gain. No response was obtained from all the treatments. The final diagnosis was camptocormia triggered by lumbar-disc herniation. He was applied supportive psychotherapy, psychoeducation regarding secondary gain, strong suggestions to improve posture, positive reinforcement, and behavioral therapy. His postural abnormality resolved and disappeared completely with mild pain. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

针灸推拿治疗腰椎间盘突出对照研究

目的：探讨针灸推拿治疗腰椎间盘突出临床效果。方法整群选取该院2013年1月—2015年1月对收治的164例腰椎间盘突出症患者治疗方法进行回顾性分析,随机分为2组各82例,观察组采用针灸推拿治疗,对照组采用单纯推拿治疗,比较两组疗效。结果观察组总有效率为95.3%,症状平均消失时间为（12.6±2.1）d,对照组总有效率为76.8%,症状平均消失时间为（23.4±3.5）d,两组比较差异有统计学意义（P＜0.05）。结论针灸推拿是治疗腰椎间盘突出症的有效方法,值得临床应用。     

内镜手术治疗高血压脑出血合并脑疝患者的疗效和安全性探讨

目的研究采用神经内镜手术清除高血压脑出血合并脑疝患者的颅内血肿同时保留骨瓣的疗效和安全性。方法回顾性分析该科2015年1月-2017年6月行手术治疗的高血压脑出血合并一侧瞳孔散大的患者,共计54例。排除双侧瞳孔散大,术前行床边CT血管造影(CTA)排除合并动脉瘤、动静畸形和烟雾病等。其中神经内镜手术组23例,开颅手术组31例。比较两组病例的手术时间、术中出血量、血肿清除率,术后再出血、脑梗死和死亡的发生率。术后3个月行格拉斯哥预后评分(GOS)。结果神经内镜治疗组在手术时间、术中出血量上均优于开颅组,两组间差异有统计学意义;而两组间血肿清除率、术后再出血和脑梗死的发生率差异无统计学意义。尽管术后3个月GOS评分总体上内镜组与开颅组无显著差异,但内镜组植物生存率与重残率较开颅组有下降,而轻残率明显增加。结论神经内镜手术治疗脑出血合并脑疝患者手术安全,同时损伤小、降低了植物生存率与重残率。     

Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion under intraoperative neuromonitoring: A case report

Introduction:Traditional open discectomy and intervertebral fusion surgery is the common strategy for lumbar disc herniation (LDH). However, it has the disadvantages of long recovery time and severe paravertebral soft tissue injury. Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion (ZELIF), as a novel minimally invasive surgical technique for LDH, has the advantages in quicker recovery, less soft tissue destruction, shorter hospital stays and less pain. We report a novel technique of ZELIF under intraoperative neuromonitoring (INM) for the treatment of LDH.Patient concerns:A 51-year-old male presented to our hospital with left lower extremity pain and numbness for 1 year.Diagnosis:Lumbar disc herniation (LDH).Interventions:This patient was treated with Zina percutaneous screw fixation combined with endoscopic neural decompression, endplate preparation, and intervertebral fusion through Kambin''s triangle. Each step of the operation was performed under INM.Outcomes:The follow-up period lasted 12 months; the hospitalization lasted 4 nights; the blood loss volume was 65 ml, and the time of operation was 266 min. INM showed no neurological damage during the surgery. No surgical complications, including neurological deterioration, cage migration, non-union, instrumentation failure or revision operation, were observed during the follow-up period. Visual Analogue Scale (VAS) score reduced from 7 to 1; the Oswestry Disability Index (ODI) decreased from 43 to 14; the EQ-5D score was 10 preoperatively and 15 at the final follow-up visit; the Physical Component Summary of the 36-Item Short Form Health Survey (SF-36) was 48 preoperatively and 49 at the last follow up visit; the SF-36 Mental Component Summary was 47 before surgery and decreased to 41 postoperatively.Conclusion:ZELIF under INM may represent a feasible, safe and effective alternative to endoscopic intervertebral fusion and percutaneous screw fixation, for decompressing the lumbar''s exiting nerve root directly with minimal invasion in selected patients.