肌电图对腰神经后根节段定位作用的实验研究

目的:探讨应用肌电图行大鼠腰神经后根节段定位的方法。方法:通过电生理的方法,依次电刺激L3￣L5脊神经后根,分别记录大鼠双侧下肢主要肌肉的肌电图像,测量最早出现的感觉神经动作电位(SNAP)最大波幅值。结果:刺激L3脊神经后根,于股四头肌记录到的波幅峰值(480.8±255.9μV)显著高于其它各组肌肉(P<0.01)。刺激L4脊神经后根,于下肢四组肌肉记录到的CMAP最大波幅平均值均>100μV,其中在股四头肌(305.2±131.5μV)、胫骨前肌(340.2±310.4μV)记录到的波幅峰值显著高于在股二头肌(142.4±144.7μV)、腓肠肌(138.2±127.6μV)记录到的波幅峰值(P<0.01)。刺激L5脊神经后根,于股二头肌(377.5±264.4μV)、腓肠肌(168.4±126.7μV)记录到的波幅峰值显著高于其它各肌群记录到的波幅峰值(P<0.01)。结论:电刺激不同脊神经后根,在大鼠下肢不同肌肉记录到的SNAP的波幅峰值存在差异,综合分析记录到的SNAP的波幅峰值,可作为腰神经后根节段定位的参考。     

计算机体层成像多平面重建在评价椎间融合中的作用

目的 探讨计算机体层成像多平面重建(CTMPR)在评价椎间融合中的作用,寻找定量评价椎间融合的新方法.方法 13例行腰椎间融合的患者术后1周、3个月、6个月行CTMPR,行椎间融合器(Cage)内植骨CT值定量测量.结果 术后1周Cage内植骨CT值为(619.52±26.97)Hu,术后3个月为(628.69±42.60)Hu,术后6个月为(657.77±37.43)Hu.术后1周与术后3个月相比无显著性差异,与术后6个月相比有显著性差异.结论 CT值的测量在椎间融合的判断中具有高准确性.     

A comparative study of the anatomical,radiological and therapeutic features of the lumbar facet joints

Summary An anatomical study of the lumbar apophyseal joints was carried out to facilitate recognition of facet joint lesions, which we now examine routinely by percutaneous arthrography. Special attention was given to the configuration of the different compartments of the joint space and to its relationships with the contents of the intervertebral foramen. The abnormalities seen on lumbar facet joint arthrography are very varied; two major groups should be stressed: synovial fringe hypertrophy and pseudodiverticular synovial ectasia. The percutaneous approach to lumbar facet joint arthrography allows it to be used a therapeutic measure, with injection of anti-inflammatory drugs into the joint space, the beneficial effects of which were confirmed in our series. The precision, efficiency and cost-effectiveness of this outpatient technique justify and should encourage its more widespread application in the diagnosis and treatment of low back pain.     

经皮穿刺腰椎间盘切吸术治疗腰椎间盘突出症的远期疗效

目的 观察X线电视引导下经皮穿刺腰椎间盘切吸术治疗腰椎间盘突出症的远期疗效。方法 32例经CT扫描证实的腰椎间盘突出症患者，其中，膨出型29例，游离型2例，以及突出型1例，均经X线电视引导下经皮穿刺腰椎间盘切吸术治疗，术后均经随访0.5～11.0a。结果 术后1周～3个月，32例中的24例临床症状与体征得到有效控制或明显减轻，随访5～11a观察表明，症状完全消失和明显减轻者分别见于23例和6例，总有效率90.6%，预后极好和较好者均见于膨出型腰椎间盘突出症患者。结论 游离型和突出型腰椎间盘突出症的疗效均不理想，因此，术前认真选择适应证是获得理想疗效的关键性因素。     

The role of JOA score as an indication for surgical or conservative treatment of symptomatic degenerative lumbar spinal stenosis

Abstract The aim of this study was to evaluate the short- to medium-term results (up to 2 years) of conservative and surgical treatments of patients with symptomatic lumbar stenosis. To our knowledge, no previous study has provided strict indications for conservative or surgical treatment. We retrospectively studied 184 patients, who were divided into 3 groups according to JOA (Japanese Orthopaedic Association) score. A cutoff JOA score was arbitrarily fixed at 7. Patients with a score ≤7 (n=12; group A) underwent surgery, while patients with a score >7 (n=172) were conservatively treated. Group A included patients surgically treated within two months from diagnosis. Group B consisted of 144 patients who received conservative treatment, while group C (28 patients) represented patients who underwent surgery after a period of failed conservative treatment. The outcomes of surgical and conservative treatments were evaluated after 12 and 24 months, and were rated as satisfactory, not totally satisfactory, not satisfactory or totally unsatisfactory. Conservative treatment consisted of physical, orthotic and drug therapy, whereas surgical treatment included spinal decompression and instrumentation (if indicated), either rigidly or dynamically performed. Surgery was indicated in 22% of all patients and we obtained excellent results in 85% of them. Operative treatment provides excellent results for patients with severe clinical presentation (JOA score ≤7), while individuals with mild to moderate spinal stenosis (JOA score >7) should receive conservative treatment.     

后凸成形术结合体位复位治疗创伤性胸腰椎椎体骨折的临床观察

目的：观察在体位复位辅助下后凸成形术治疗创伤性胸腰椎椎体骨折的临床疗效。方法：37例新鲜单节段胸腰椎椎体骨折患者,男28例,女9例;年龄24～79岁,平均48岁。通过体位复位及Sky扩张器撑开复位后,经双侧椎弓根穿刺充填自固化磷酸钙人工骨（CPC）。根据Denis胸腰椎骨折的分型：压缩性骨折,B型27例,C型3例,D型5例;爆裂性骨折2例,均为B型。利用体位复位,经皮穿刺,Sky椎体成形器扩张椎体,注入可降解的自固化磷酸钙人工骨。根据术前和术后侧位X线片测量椎体高度、后凸畸形角度,并计算椎体高度丢失率和后凸畸形矫正率,记录分析视觉模拟评分（VAS）及伤椎形态变化。结果：术后随访9～24个月,平均13个月。术后伤椎处疼痛均显著缓解,VAS评分改变从术前平均（7.6±2.5）分降至术后平均（1.8±1.5）分,椎体前壁高度和中间高度明显恢复,后凸畸形得到矫正。随访期间疗效满意,伤椎高度无明显丢失。结论：在严格掌握适应证、选择合适病例的前提下,采用体位复位辅助下经皮椎体后凸成形术治疗创伤性胸腰椎椎体骨折,能迅速缓解疼痛,有效恢复椎体高度和矫正后凸畸形。     

螺旋CT扫描与多模式三维重建诊断腰椎间盘突出症

目的 探讨螺旋CT扫描容积数据与三维重建诊断腰椎间盘突出症(LDH)的价值。资料与方法 94例行连续容积扫描：准直3～5mm，螺距1．5～3．0，以1．3～2．7mm间距后重建；源影像输入AW4．0工作站，应用多平面重建(MPR)、表面遮盖显示(SSD)和仿真内镜(VE)等软件显示病变，并与椎间盘镜(MED)诊治对照。结果 8例正常；LDH86例：中央型、侧旁、椎间管、椎管外、侧方及混合型分别为19、39、5、2、3、18例。三维重建显示LDH的立体结构为堤坡形、扁丘形、尖丘形、双(多)丘形及游离形分别为34、26、9、5、2例。VE诊断LDH的准确度、灵敏度、特异度分别为95％、100％、80％。VE能模拟MED效果。结论 容积数据与多模式三维重建能提供诊断LDH更全面的信息，并模拟微创手术治疗。     

腰椎疾患对男性性功能影响的临床观察

目的:探讨腰椎疾患对男性性功能的影响和心理干预治疗的效果.方法:157例伴有性功能障碍的男性腰椎疾患患者分为单纯腰椎疾患组(82例,A组)和继发马尾神经综合征组(75例,B组),治疗前填写国际勃起功能指数评分表(IIEF-5)、艾森克个性问卷(EPQ),同时行球海绵体肌反射(BCR)、坐骨海绵体肌反射(ICR)、阴茎背神经体感诱发电位(SSEP)潜伏期、波幅的检测.A组患者分为对照组和心理干预组;B组患者经临床分为早、中、晚期后再分为对照组和心理干预组.对照组均给予手术治疗.心理干预组除了手术治疗外,同时给予心理干预治疗.治疗后再次采用IIEF-5和BCR、ICR、SSEP检测,并与治疗前进行统计比较.结果:A组患者性功能障碍主要为轻度勃起功能障碍(ED),而B组患者主要为重度ED.A组患者BCR、ICR、SSEP检测结果同正常值相比无显著性差异(P>0.05):心理干预组IIEF-5评分较对照组显著提高(P<0.05).B组患者中,轻度ED患者潜伏期较正常值和A组延长(P<0.05),中度ED和重度ED患者潜伏期延长更加明显(P<0.05);处于临床早期的患者心理干预治疗组性功能的改善情况好于对照组(P<0.05),但是处于临床中、晚期的患者治疗组与对照组的差异不明显(P>0.05).结论:单纯腰椎疾患及临床早期马尾神经综合征患者性功能障碍的发生主要受心理因素的影响,而中晚期马尾神经综合征患者以神经功能损伤为主.心理治疗能够改善单纯腰椎疾患及临床早期马尾综合征患者的性功能,对处于临床中、晚期的马尾神经综合征患者效果不明显.     

腰丛-坐骨神经联合阻滞在高龄老年患者股骨上段骨折手术中的应用

目的探讨腰丛-坐骨神经联合阻滞用于高龄老年患者股骨上段骨折手术的效果。方法2006年7月~2007年10月在腰丛-坐骨神经联合阻滞下行股骨上段骨折手术的高龄老年患者47例,ASAⅡ或Ⅲ级,年龄75~103岁,分为股骨头置换组(Ⅰ组,n=35)和动力髋螺钉系统术组(DHS)(Ⅱ组,n=12),合并有高血压、糖尿病、冠心病、脑梗死或肺部疾患。在神经刺激器定位下行腰丛-坐骨神经联合阻滞,腰丛阻滞注射0.3%罗哌卡因25~30ml,坐骨神经阻滞注射0.3%罗哌卡因15~30ml。结果97%的患者阻滞效果完善,Ⅰ组患者需喉罩辅助,Ⅱ组患者单纯应用神经阻滞即可满足手术要求;手术开始时Ⅰ组患者的HR增快,SBP及DBP明显下降(P<0.05),手术开始后5min仍下降明显(P<0.05),而Ⅱ组患者手术前后HR及BP无明显变化;术中、术后未见不良反应。结论腰丛-坐骨神经联合阻滞适合于高龄老年患者股骨上段骨折手术。