采用3.0T MRI T2和T2* mapping评价下腰痛患者腰椎间盘退变

目的探讨下腰痛患者腰椎间盘的T2和T2*值与退变Pfirrmann分级的相关性,明确T2和T2*值是否可以作为影像学生物标记定量评价IVD退变。方法 2015年3月-2015年6月间,对66例下腰痛患者采用3.0T MRI行腰椎常规结构成像和定量成像(T2和T2*mapping)。Pfirrmann分级由两位放射诊断医生依据矢状位T2WI通过协商进行。在正中矢状位的T2 map和T2*map上由一位放射诊断医生手工绘制感兴趣区尽可能包括髓核和内层纤维环测量IVD的T2和T2*值。采用Pearson相关比较IVD的T2和T2*值与Pfirrmann分级相关性,并对相邻的Pfirrmann分级的T2和T2*值比较。结果 IVD的T2和T2*值与Pfirrmann分级呈负相关,相关系数分别为-0.612和-0.354,P值均小于0.001。PfirrmannⅠ级到Ⅲ级T2和T2*值显著降低,Ⅲ级到Ⅴ级下降变缓。除Ⅳ级与Ⅴ级IVD的T2和T2*值差别没有统计学意义外,其他相邻的Pfirrmann分级IVD的T2和T2*值差别均有统计学意义。结论 IVD的T2和T2*值具有作为影像学生物标记定量评价IVD的退变潜在可能性,有助于IVD退变的早期诊断和客观评价退变程度。晚期IVD退变T2和T2*值下降变缓,以形态学改变为主。     

单纯腰痛性中央型腰椎间盘突出症50例临床观察及治疗

目的：研究并分析治疗单纯腰痛性中央型腰椎间盘突出症患者时使用中药联合牵引治疗的效果。方法：收集单纯腰痛性中央型腰椎间盘突出症患者共100例,根据患者入院日期的单双号数分为50例对照组和50例观察组,对照组患者接受中药治疗,观察组在此基础上联合使用牵引治疗。结果：观察组患者治疗后的总有效率明显高于对照组（P ＜0.05）。结论：在单纯腰痛性中央型腰椎间盘突出症患者的治疗过程中,中药内服联合牵引治疗能够获得满意效果,并极大缓解患者的痛苦,值得推广应用。     

Type II collagen and aggrecan mRNA expression by in situ hybridization in rabbit temporomandibular joint posterior attachment following disc displacement

Pathological changes and mRNA expression were studied in the posterior attachment of 40 adult Japanese white rabbits. The right temporomandibular joints of 28 rabbits were subjected to surgical disc displacement. Joints were studied by histochemistry and in situ hybridization. The collagen in the posterior attachment became dense, especially near the posterior band of the disc. Chondrocytes were found not only in the disc but also in the posterior attachment. Sometimes cartilage formation was seen. Type II collagen mRNA expression was first detected in the posterior attachment 4 days postoperatively and became progressively stronger with time. Aggrecan expression in the posterior attachment decreased at first, then increased gradually. It was concluded that, in the temporomandibular joint, chondrocytes appear in the posterior attachment as a result of biomechanical stimuli and the attachment becomes fibrocartilaginous following disc displacement.     

双极射频靶点热凝术治疗侧方型腰椎间盘突出症观察

观察单侧椎板间隙置针双极射频靶点热凝术治疗侧方型腰椎间盘突出症的临床疗效。回顾性分析2013年1月至2014年1月间的侧方型腰椎间盘突出症163例,其中L4～5突出68例,L5S1突出53例,L4～5、L5S1突出42例,采用单侧椎板间隙行双极射频消融治疗;在C型臂X线机下用穿刺导针确定入针位置,穿刺到位后,进行感觉、运动电刺激测试,经测试无误后,一般给予55 ℃ 180 s、65 ℃ 180 s、75 ℃ 180 s各一次连续射频治疗;术后去枕平卧6 h,绝对卧床休息1 d,给予常规脱水机预防感染等治疗,术后24 h开始行直腿抬高等康复训练。163例中146例完成随访,随访时间9～12个月,平均10个月。参照改良Macnab方法评价标准判定：优73例,良56例,可10例,差7例;有效率95.21%,优良率88.36%。经单侧椎板间隙置针双极射频靶点热凝治疗侧方型腰椎间盘突出症,是一种简捷、安全、有效的微创方法,可以提高临床疗效,减少并发症,值得推广应用。     

腰围固定用于防治LDH反复发作型腰腿痛的临床随机对照研究

目的:观察腰围固定疗法治疗腰椎间盘突出症(LDH)反复发作型腰腿痛的临床疗效并探讨其作用机理。方法:将腰椎间盘突出症反复发作型腰腿痛患者120例随机分为试验组和对照组各60例。对照组采用电针及低频电疗法。试验组在对照组治疗的基础上增加腰围固定疗法,于治疗前及治疗后1个月、3个月、1年对2组患者分别进行疼痛、腰部功能评估、腰肌萎缩发生率和ASE评分。结果:2组治疗后不同治疗阶段(治疗后1个月,3个月,1年)的VAS分值和ODI总评分均低于治疗前,差异具有统计学意义(P0.001),治疗后3个月及1年2组间比较差异具有统计学意义(P0.001)。2组治疗后3个月及1年后腰肌萎缩的发生率相比差异无统计学意义(P0.05)。结论:腰围固定疗法从远期疗效来看能更加有效缓解腰椎间盘突出症患者的疼痛,改善腰椎功能,且腰肌萎缩的发生率未增高,是一种治疗腰椎间盘突出症安全有效的方法。     

A sign on CT that predicts a hazardous ureteral anomaly

IntroductionAn aberrant course of the distal ureter can pose a risk of ureteral injury during surgery for inguinal hernia repair and other groin operations. In a recent case series of inguinoscrotal hernation of the ureter, we found that each affected ureter was markedly anterior to the psoas muscle at its mid-point on abdominal CT. We hypothesized that this abnormality in the abdominal course of the ureter would predict the potentially hazardous aberrant course of the distal ureter.Presentation of casesWe reviewed all evaluable CT urograms performed at St. Louis University Hospital from June 2012 to July 2013 and measured the ureteral course at several anatomically fixed points.Discussion93% (50/54) of ureters deviated by less than 1 cm from the psoas muscle in their mid-course (at the level of the L4 vertebra). Reasons for anterior deviation of the ureter in this study included morbid obesity with prominent retroperitoneal fat, congenital renal abnormality, and post-traumatic renal/retroperitoneal hematoma. We determined that the optimal level on abdominal CT to detect the displaced ureter was the mid-body of the L4 vertebra.ConclusionAnterior deviation of the ureter in its mid-course appears to predict inguinoscrotal herniation of the ureter. This finding is a sensitive predictor and should raise concern for this anomaly in the appropriate clinical setting. It is not entirely specific as morbid obesity and congenital anomalies may result in a similar imaging appearance. We believe that this association has not been reported previously. Awareness of this anomaly can have significant operative implications.     

搜风通络汤治疗PEID术后20例神经根症状临床研究

目的:通过临床对比研究,分析搜风通络汤对腰椎间盘突出症经皮椎间孔镜技术(PEID)术后神经根症状恢复情况的影响,并与肌松药盐酸乙哌立松功效作比较。方法:选择腰椎间盘突出症PEID术后患者60例,随机分成基础组、治疗组、对照组各20例,基础组予地塞米松抗炎止痛联合甘露醇脱水治疗,治疗组加服搜风通络汤,对照组加用盐酸乙哌立松,分别在术后3 d、术后1周、术后4周三个时间点用JOA评分和VAS评分评价三组治疗效果。结果:术后3 d,三组之间JOA及VAS评分差异无统计学意义(P0.05);术后1周、术后4周,三组之间JOA及VAS评分差异有统计学意义(P0.05),治疗组与对照组疗效优于基础组,且治疗组疗效优于对照组;结论:搜风通络汤对腰椎间盘突出症PEID术后遗留神经根症状有持续改善效果,并且临床疗效优于盐酸乙哌立松。     

腰突颗粒治疗气滞血瘀及肝肾亏虚型腰椎间盘突出症疗效对比研究

目的 :对比研究腰突颗粒治疗气滞血瘀型和肝肾亏虚型腰椎间盘突出症的临床疗效。方法 :选取腰椎间盘突出症患者270例,A组90例为气滞血瘀证型,B组90例为肝肾亏虚证型,C组90例未予中医辨证。A、B两组均口服腰突颗粒煎煮剂,每次服用20 m L,日2次;C组口服双氯芬酸钠双释放肠溶胶囊,一次75 mg,日2次。三组均以10 d为一疗程,持续服药2疗程。服药前、服药1疗程后、服药2疗程后分别对三组患者进行疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评价。服药2疗程后参照《中医病证诊断疗效标准》进行疗效评价。结果 :三组治疗1、2疗程后VAS评分、ODI指数均降低,与治疗前比较,差异有统计学意义(P0.05);A组治疗1、2疗程后的VAS评分、ODI指数明显低于B、C两组,差异有统计学意义(P0.05)。A组临床总有效率和治愈率均优于其他两组,差异有统计学意义(P0.05)。结论:腰突颗粒对气滞血瘀型腰椎间盘突出症的疗效优于肝肾亏虚型。     

针刺天柱穴配合推拿治疗血瘀型腰椎间盘突出症临床研究

目的:观察针刺天柱穴配合推拿治疗血瘀型腰椎间盘突出症的临床疗效。方法:将58例血瘀型腰椎间盘突出症患者随机分为治疗组28例和对照组27例,对照组给予推拿疗法,治疗组在对照组的基础上给予针灸疗法,比较两组患者治疗前后Oswestry功能障碍问卷表(Oswestry disability index,ODI)评分及血清P物质(substance P,SP)水平变化情况。结果:两组患者治疗后SP水平及ODI评分优于治疗前,且治疗组优于对照组,差异均有统计学意义(P0.05)。结论:针刺天柱穴配合推拿治疗血瘀型腰椎间盘突出症疗效显著。     

中西医结合治疗老年腰椎间盘突出症49例

目的:观察中西医结合治疗老年腰椎间盘突出症(Senile lumbar disc herniation,SLDH)的临床疗效。方法:将97例SLDH患者随机分为对照组48例和观察组49例,对照组采用基础治疗,观察组在基础治疗的同时加局部封闭和自拟伸筋汤内服。观察两组患者的临床疗效及治疗前后疼痛评分情况。结果:观察组有效率为98.0%,对照组有效率为79.2%,两组有效率比较,差异具有统计学意义(P0.05)。治疗后两组患者VAS积分均较治疗前降低,且观察组优于对照组,差异均有统计学意义(P0.05)。结论:中西医结合治疗SLDH,能快速改善腰腿疼痛症状,恢复病变周围组织的正常生理功能,不良反应少,疗效确切。