优质康复护理干预对腰椎管狭窄症行椎间孔镜术后患者的影响

目的探讨优质康复护理干预对腰椎管狭窄症行椎间孔镜术后患者的影响。方法选取2017年1月至2018年12月我院收治的行椎间孔镜术腰椎管狭窄症患者80例为研究对象,随机将其等分为对照组与研究组,对照组给予常规术后护理,研究组在对照组基础上给予术后优质康复护理干预,比较两组的疼痛评分(VAS)、日常生活能力评分(ADL)和功能障碍指数评分(Oswestry)。结果干预前两组VAS评分、Oswestry评分、ADL评分比较差异无统计学意义(P>0.05);干预后研究组VAS评分、Oswestry评分显著低于对照组,ADL评分高于对照组,差异具有统计学意义(P<0.05)。结论优质康复护理干预可明显改善腰椎管狭窄症患者行椎间孔镜术后的疼痛情况、恢复其腰椎正常功能,提高生活质量,值得推广应用。     

腰神经根受压对下肢肌力影响的定量化检查

为了了解腰脊神经根受压后对肌力影响的程度，本文应用Ｃｙｂｅｘ一６０００型等速肌力测试系统对１０１例门诊病人的二侧踝屈、伸肌群进行测量，测出峰力矩、一次作功、平均功率、力矩加速能、多次总作功、耐力以及踝屈伸主动肌与桔抗肌的肌力比值。发现患侧除耐力与健侧差别不大外，其余能力大多低于健侧２０～３０％，患侧踝屈伸肌力和作功能力明显低于健侧，其发生率约为７０～８０％。     

中药离子导入配合湿热敷对腰椎间盘突出症疗效观察及护理

目的探讨中药离子导入配合中药湿热敷对腰椎间盘突出症的疗效及护理体会。方法将40例腰椎间盘突出症患者随机分为观察组和对照组各20例,2组均采用中药湿热敷疗法,对照组单纯采用中药湿热敷疗法,观察组采用中药离子导入配合中药湿热敷疗法。结果观察组治疗效果优于对照组,治疗后2组间比较疼痛评分、临床疗效差异具有统计学意义(P0.05)。结论中药离子导入配合中药湿热敷对腰椎间盘突出症的疗效优于单纯中药湿热敷治疗。     

康复专科护理规范化流程管理在腰椎间盘突出症患者保守治疗中的效果观察

目的 观察康复专科护理规范化流程在腰椎间盘突出症患者保守治疗中的应用效果.方法 回顾性分析我科198例接受保守治疗的腰椎间盘突出症患者,按时间段分为对照组和观察组,对照组2013年7月至12月收治的92例患者采用传统常规护理方法,观察组2014年1月至6月收治的106例患者在常规护理基础上规范康复专科护理流程:根据患者病情与发展阶段制定并按顺序实施康复专科护理措施,即急性水肿期的卧床休息及心理护理、疼痛护理、正确卧位姿势训练与上下床转移训练;疼痛缓解期的腰椎牵引护理、腰围护理、中医透药、针灸理疗护理;恢复期腰背肌功能锻炼、脊柱保健操文体康复,以及出院前的健康指导等康复专科护理方法.观察两组患者疾病症状改善时间、总疗程、总有效率、1年复发率以及不良反应等.结果 观察组患者临床症状改善时间、总疗程及治疗效果明显优于对照组(P<0.05),随访1年复发率也明显低于对照组(P<0.05),临床治疗过程中两组均未发生明显不良反应.结论 规范化的康复专科护理流程管理可以快速有效缓解腰椎间盘突出症患者的症状,提高治愈率,缩短康复时间,减少复发率,可明显改善腰椎间盘突出症患者的生活质量和活动能力.     

A meta-analysis of artificial total disc replacement versus fusion for lumbar degenerative disc disease

Lumbar fusion has been developed for several decades and became the standard surgical treatment for symptomatic lumbar degenerative disc disease (DDD). Artificial total disc replacement (TDR), as an alternative for spinal arthrodesis, is becoming more commonly employed treating lumbar DDD. It is still uncertain whether TDR is more effective and safer than lumbar fusion. To systematically compare the effectiveness and safety of TDR to that of the fusion for the treatment of lumbar DDD, we performed a meta-analysis. Cochrane review methods were used to analyze all relevant randomized controlled trials published up to July 2009. Five relevant randomized controlled trials involving 837 patients were identified. Patients in TDR group have sightly better functioning and less back or leg pain without clinical significance, and significantly higher satisfaction status in TDR group compared with lumbar fusion group at the 2-year follow-up. But these outcomes are highly influenced by the study with BAK cage interbody fusion, the function/pain and patient satisfaction status are no longer significantly different between two groups after excluding this study. At 5 years, these outcomes are not significantly different between comparing groups. The complication and reoperation rate of two groups are similar both at 2 and at 5 years. In conclusion, TDR does not show significant superiority for the treatment of lumbar DDD compared with fusion. The benefits of motion preservation and the long-term complications are still unable to be concluded. More high-quality RCTs with long-term follow-up are needed.     

Dural lesions in lumbar disc herniation surgery: incidence, risk factors, and outcome

In lumbar disc herniation surgery, dural lesions seem to be the most common complication today. Studies on incidence of and outcome after a dural lesion are mainly based on retrospective studies. In a prospective study within the framework of the Swedish Spine Register, 4,173 patients operated on for lumbar disc herniation were evaluated using pre- and 1-year postoperative protocols and complication registration. Mean patient age was 41 (18–81) years and 53% of the patients were male. 93% of the operations were performed on the two lowermost lumbar levels. The incidence of dural lesions in the material was 2.7%. In patients with previous disc surgery, the incidence was doubled, 5%, a significant increase (P = 0.02). Patients with dural lesions preoperatively had more back pain and inferior scores in general health and role emotional domains of the SF-36. These factors, however, were because they had been operated on previously, not related to the dural lesion as such. The relative improvement after surgery was similar whether a dural lesion had occurred or not. It is concluded that a dural lesion is a technical complication which must be solved at the time of surgery but which does not bear any negative implications on the long-term outcome for the patient.     

Recompression of vertebral body after balloon kyphoplasty for osteoporotic vertebral compression fracture

The purpose of this retrospective clinical study was to evaluate the factors that affect recompression of operated vertebrae after percutaneous balloon kyphoplasty (PKP) for osteoporotic vertebral compression fractures (VCFs) and assess their clinical importance. PKP has been used for VCFs with satisfactory results. Several studies about subsequent VCFs adjacent to cemented vertebrae have been reported after PKP. However, the presence and significance of recompression of operated vertebrae have not been adequately described. In total, 80 patients treated with PKP for single thoracolumbar VCFs were reviewed. The follow-up period was at least 1 year. Patients were divided into those without recompression (maintained group, n = 70) and those with recompression (recompressed group, n = 10). Plain roentgenography (preoperative, operative, and last), preoperative BMD, and preoperative MRI were checked. Age, gender, T-score in BMD, duration of symptom, compression rate (CR) of VCF, reduction rate, kyphotic angle (KA), reduction angle, intervertebral cleft (IVC), and non-PMMA-endplate-contact (NPEC) were evaluated. To evaluate the clinical results, we checked the VAS score at each follow-up period. All data were analyzed statistically. The CR for the recompressed group increased significantly after surgery and decreased at the last follow-up (p < 0.05). The last CR was not significantly different from the preoperative CR. The KA showed the same pattern. The preoperative, postoperative, and last VAS scores were significantly different from one another in both groups (p < 0.05). Between the groups, preoperative KA, postoperative KA, last KA, IVC, and NPEC were significantly different (p < 0.05). In particular, last KA, IVC, and NPEC showed highly significant differences (p < 0.001). In a correlation test for the evaluated factors, IVC (r = 0.557) and NPEC (r = 0.496) were the most significant. The presence of IVC and NPEC may play an important role in inducing recompression of treated vertebrae after PKP. Careful observation of patients with these conditions is necessary to prevent deterioration of their clinical course.     

Lumbar posterolateral fusion inhibits sensory nerve ingrowth into punctured lumbar intervertebral discs and upregulation of CGRP immunoreactive DRG neuron innervating punctured discs in rats

Degeneration of lumbar intervertebral discs is thought to be a cause of low back pain. Studies have found that a cause of discogenic low back pain is intervertebral disc inflammation and axonal growth of afferent fibers innervating the disc. Lumbar spine fusion for chronic discogenic low back pain is considered an effective procedure. However, no study has investigated the mechanism of pain relief. We did this by applying Fluoro-Gold (FG) to the ventral aspect of the L4–L5 intervertebral discs of 40 rats. We exposed the nucleus pulposus to the annulus fibrosus in a disc punctured model. Rats were divided into 4 groups. Group A: Punctured intervertebral disc with sham posterolateral fusion (PLF) (n = 10), Group B: Punctured intervertebral disc with PLF (n = 15), Group C: Normal intervertebral disc (no puncture) with PLF (n = 10), and Group D: Normal disc (no disc puncture) with sham PLF (n = 5). Four weeks after surgery, bilateral L1–L5 dorsal root ganglia (DRGs) were stained with growth-associated protein 43 (GAP43), a marker of axonal growth, and calcitonin gene-related peptide (CGRP), a neuropeptide marker of pain. Bone union was evaluated using X-ray imaging. Of the FG-labeled neurons, the proportions of GAP43- and CGRP-immunoreactive (IR) neurons in Group A were significantly higher than in Group D (P < 0.05). The proportions of GAP43- and CGRP-IR neurons in bone union rats in Group B were significantly lower than in nonunion rats in Group B and in the rats in Group A (P < 0.05). No significant differences in GAP43- and CGRP-IR neurons were observed between bone union and nonunion rats in Group C and the rats in Group D (P > 0.05). PLF is strongly related to the downregulation of GAP43 and CGRP expression. Therefore, PLF may suppress the increase of inflammatory neuropeptides and the process of axonal growth. Moreover, these results may explain, in part, the mechanism of pain relief following lumbar spinal fusion for chronic discogenic low back pain in humans.     

可动式椎间盘镜下单侧开窗双侧减压治疗腰椎管狭窄症

目的 探讨可动式椎间盘镜下单侧开窗双侧减压治疗腰椎管狭窄症的疗效.方法 2007年6月至2009年6月采用可动式椎间盘镜下单侧开窗双侧减压治疗退行性腰椎管狭窄症32例,男14例,女18例;年龄56～74岁,平均65岁.均为双侧椎管狭窄合并椎问盘突出,有间歇性跛行和坐骨神经痛等症状,双下肢症状以一侧为重.在症状严重侧行棘突旁2 cm纵切口,在可动式椎间盘镜下行单侧椎板间隙开窗,神经根通道减压、突出髓核摘除;在棘突和椎板腹侧分别向上、下方用棉片压低保护硬膜囊,潜行咬除棘突基底部,在棘突基底、椎板腹侧与硬膜囊背侧之间形成工作空间,经此空间潜行咬除对侧椎板下缘和增厚的黄韧带,直至显露松解对侧神经根起始部.结果 术中无神经损伤发生,无中途转开放手术病例.发生硬膜囊撕裂2例,用棉片将其压低后完成手术.手术时间5～100min,平均70min;术中出血量50～350ml,平均150ml.术后CT示减压充分,中央椎管和对侧椎管扩大,对侧椎板、关节突和椎旁肌等结构保留完好.全部病例随访6～24个月,平均12个月.根据Macnab标准,优21例,良11例.结论 可动式椎间盘镜下单侧开窗双侧减压治疗腰椎管狭窄症操作简便,能保留对侧结构,达到双侧减压目的 ,早期随访结果优良.对双侧严重骨性狭窄者应慎用.     

内窥镜下不同入路治疗L_5S_1椎间盘突出症

目的 探讨局麻下经皮后外斜入路与椎板间孔入路内窥镜手术治疗L_5S_1椎间盘突出症的临床疗效.方法 自2003年6月至2008年10月,对57例L_5S_1椎间盘突出症患者应用内窥镜下髓核摘除术进行治疗.男32例,女25例;年龄17～79岁,平均42岁.内窥镜手术入路分别采用后外斜入路与椎板间孔入路.应用Oswestry功能障碍指数对患者手术前、后腰椎功能状况进行评价,分析不同入路的治疗结果、并发症、二次开放手术等情况.结果 57例患者均获得随访,最长5年4个月,最短12个月,平均22.4个月.采用后外斜入路22例,椎板间孔入路35例,其中各有1例患者接受二次手术,各有1例术后出现感染.后外斜入路突出的部位更靠外侧.椎板间孔入路不考虑髂棘的高低,突出部位为中央型和旁中央型.后外斜入路组手术前、后平均Oswestry功能障碍指数分别为74.36,13.91(P<0.001),椎板间孔入路为77.45,12.56(P<0.001),术前和术后两者之间的差异无统计学意义.按照MacNab标准,末次随访时手术疗效后外斜入路优良率为86%.椎板间孔入路优良率为89%.结论 两种入路各有不同的适应证,手术过程明显不同,但只要选择恰当,均能达到很好的临床疗效.