超声刀在MED治疗腰椎间盘突出症中的应用

目的 探讨超声刀应用于后路脊柱显微内窥镜椎间盘摘除术(Microendoscopic Discectomy MED)治疗腰椎间盘突出症中的优势与疗效.方法 我院自2005年1月～11月将根据患者症状、体征、体查、CT和或MRI确诊的腰椎间盘突出症患者97例随机分为两组,超声刀 MED组45例,采用超声刀处理椎板下缘等骨性结构;而常规MED手术组52例采用枪钳或电动磨钻处理.结果 超声刀 MED组与常规MED组平均手术时间分别为42 min和75 min,平均术中失血量分别为29 ml和61 ml,平均术后引流量分别为13 ml和29 ml,差异均有显著性(P＜0.05);两组所有病例获得13月(6～17月)随访,按Macnnab标准,优良率分别为95.6%和92.3%,差异无显著性(P＞0.05).结论 超声刀切割骨骼的同时不损伤软组织,且有同步止血功能,操作安全方便,能缩短MED手术时间,不失为脊柱手术一种理想的辅助工具.     

Percutaneous endoscopic lumbar discectomy (PELD)

Percutaneous endoscopic lumbar discectomy (PELD) is a new technique for the decompression of the lumbar disc space and removal of nucleus pulposus via a posterolateral approach. The technique was introduced in Germany by the authors in April 1987. The method is indicated in patients with non-equestrated lumbar disc herniation with an intact lorsal longitudinal ligament. In local anesthesia, a working cannula (OD 5 mm) is placed at the dorsal lateral border of the disc. The disc space is opened with anulus trephines and the nucleus pulposus is removed with rigid and flexible forceps as well as with automated shaver systems under intermittent endoscopic control (discoscopy). The procedure is performed in local anesthesia. The results of the first thirty patients with a follow-up time between 6 months and 17 months could be graded as excellent in 13 cases, as good in 9 cases, as fair in 6 cases, and as bad in 2 cases. The relief of symptoms as judged by the patients was between 70–100 percent in the majority of the cases. Three patients had to be reoperated at the same level and site, because of either persistent or recurrent sciatica. The performance in local anesthesia, the atraumatic extraspinal approach, the reduced time of hospitalization and post-operative morbidity as well as the reduced time of work incapability are the main advantages of this new method.     

经皮腰椎间盘切除术治疗复发性腰椎间盘突出症

目的：总结经皮腰椎间盘切除术治疗传统后路术后复发性腰椎间盘突出症的经验。方法：分析１９９５年１月至１９９８年１２月采用经皮腰间盘切除术治疗１９例复发性腰椎间盘突出症的临床资料。结果：穿刺成功率１００％,术后随访１０～３２月,平,平均２１月,优１１例、良５例,可２例,差１例,优良率８４．２％。结论：在具有再次开放手术适应症的复发性腰椎间盘突出症中,初次手术行单节段半椎板、全椎板切除和开窗术者中一侧单     

The treatment of spondylotic cervical myelopathy by ventral discectomy. Long term results on 121 patients

The pathophysiology of spondylotic cervical myeolopathy is still a matter of discussion. This paper presents a series of 126 patients operated on using a ventral approach. In 47% of the patients only a spondylotic narrowing of the spinal canal was present and in 35% an additional disc herniation was found. In 13% of the cases however a soft disc without spondylotic spures was found and in 5% a dislocation of vertebral bodies. We found a marked male preponderance of 77%, mean age was 51.6 years, ranging from 25–50 years. Most patients were operated on at the levels of C4/5 and C5/6. Observation time covered a period of 3–10 years. The outcome was rated relatively to the preoperative degree of disablement using a questionnaire for the patients and their family doctors. We found a marked difference in the answers, especially in rating deterioration, which was stated by patients in 34%, by physicians only in 12%. Another finding was the time-related out-come. We found best results with 75% improvement and 5% deterioration between 3–6 months postoperatively, with increasing time the results decreased to 33% improvement, 33% identical statys and in 33% a deterioration related to the preoperative status must be noted.     

经椎板间隙入路显微内窥镜手术治疗腰椎间盘突出症

目的：探讨经椎板间隙入路显微内窥镜手术治疗腰椎间盘突出症的手术适应证，手术存在问题及解决方法。方法：用METRX治疗腰椎间盘突出症l16例，详细介绍手术过程、操作技巧、手术适应证和术中注意问题。结果；平均随访15．1个月，按Nakal疗效评定分级属优90例，良22例，可2例，差2例，优良率96．6％。结论：严格掌握手术适应证、准确定位、娴熟操作技巧、彻底止血、术后有计划的康复训练是手术成功的关键。     

MRI-Findings After Uncomplicated Anterior Cervical Discectomy

Summary ? Background. The anterior approach for cervical discectomy with methacrylate-implant involves manipulations on vertebral bodies and ligaments. Foreign materials like methacrylate and fibrin sponge are inserted. On postoperative MRI it may be difficult to differentiate pathological from “normal” findings caused by routine manipulations.  Method. In this study 14 patients free of symptoms after anterior discectomy with methacrylate-implant were examined clinically and a MRI was performed on the 7th day after surgery and again after a 6 month follow-up. All patients had an uneventful recovery and no signs of inflammation after surgery.  Findings. Independent of the underlying pathology (e.g. soft or hard disc) 73% of the patients had a signal reduction within the vertebral bodies adjacent to the operated disc on T1-weighted spin-echo images on the 7th postoperative day. Signal intensities were normal after 6 months in all patients. Remarkable metal artifacts were present in one patient only. The methacrylate-implant could be identified as a hypo-intense structure on all sequences at any time without artifacts. In 80% of the cases a hyperintensity was found on T2-weighted images between the methacrylate-implant and the dura on the 7^th postoperative day. A protrusion of the posterior ligament was present at the level of the operated disc on day 7 after surgery, which had resolved completely 6 months later. This may mimic residual disc tissue or osteophytes early after surgery.  Interpretation. It is very important to know this “normal” postoperative appearance of the cervical spine in order to avoid misinterpretations.     

后路椎间盘镜手术治疗不典型腰椎间盘突出症

目的 观察后路椎间盘镜手术治疗不典型腰椎间盘突出症的疗效。方法 2000年10月至2006年3月从我院573例手术患者中筛选出54例不典型病例。其中定位体征不明确37例，辅助检查（CT或MRI）与查体体征不符合17例。以上患者均为保守治疗3个月无效，且症状严重影响生活质量坚持要求手术者。行后路椎间盘镜手术切除椎间盘，术后卧床休息2～3周。结果 全部患者无并发症。随访41例按Nakai疗效评定分级属优27例，良8例，可3例。随访8个月至4年总体有效率为92．68％。结论 对于不典型腰椎间盘突出症，保守治疗3个月无效时仍可考虑进行MED手术。     

腰椎间盘摘除新型三维有限元模型研究

目的 建立腰椎L4/5运动节段椎间盘摘除的三维有限元模型,用于进一步的生物力学研究.方法 将CT扫描的腰椎图像结合人体解剖学数据通过3DSMAX建模形成正常中国男性L4/5运动节段的三维模型,用有限元分析软件SAP2000转换成三维有限元模型.去除模型中L4～5椎间盘右后侧1/4的纤维环中部全层及约1/4的髓核单元,以模拟腰椎间盘摘除手术.结果 建立了L4/5运动节段椎间盘摘除的三维有限元模型.结论 通过CT断层扫描、图像数字化处理及计算机辅助设计等方法,可以建立腰椎运动节段椎间盘摘除的三维有限元模型,用于脊柱生物力学的研究.     

Could self-locking stand-alone cage reduce adjacent-level ossification development after aneterior cervical discectomy and fusion?

Numerous studies have shown that cervical arthrodesis is associated with the adjacent-segment pathology (ASP), such as adjacent-level ossification development (ALOD). However, it still remains largely unclear whether the self-locking stand-alone implant system can reduce the incidence of ALOD. In the present study, we prospectively recruited 120 patients with cervical degenerative disc disease (CDDD) who were treated by anterior cervical discectomy and fusion (ACDF). These patients were randomly and evenly divided into the ROI-C group and plate group. Clinical and radiologic follow-up was performed at 3, 6, 12, 24 and 36 months after surgery. Clinical evaluation included preoperative and postoperative assessments of Japanese Orthopaedic Association (JOA) score and Neck Disability Index (NDI) score. The presence and severity of ALOD, as well as the C2-7 Cobb angle, were assessed on the lateral cervical films during follow-up. There were no significant differences in JOA and NDI scores at each time point during the follow-up period between the two groups. ALOD occurred in 8.8% of 58 patients and 6.7% of 104 levels in the cage group. Moreover, ALOD occurred in 20.1% of 57 patients and 17.8% of 101 levels in the plate group. The ALOD was more serious in the plate group compared with the cage group. The C2-7 Cobb angle was significantly improved compared with that before the operation and could be maintained during the follow-up in both groups. The self-locking stand-alone cage was efficacious for ACDF, and it could reduce the incidence of ALOD compared with anterior plate and cage.     

Carotid Artery-Related Perioperative Stroke Following Anterior Cervical Spine Surgery: A Series of 3 Cases and Literature Review

Background

Vascular complications following anterior cervical spine surgery are rare but potentially devastating. Complications associated with the carotid artery are even more disastrous but largely anecdotal, with no more than 4 reported cases.