腰椎间盘突出症继发马尾神经综合征手术治疗的疗效

目的：研究腰椎间盘突出症继发马尾神经综合征手术治疗的疗效。方法：对６７例腰椎间盘突出症并发马尾神经综合征的患者发病因素、病程、影像学的表现特征、手术时机的选择同其治疗的随访结果进行综合分析。随访时间３个月至３．５年,平均１年４个月。结果：急性发病的患者其手术时机的选择同患者功能恢复的优良率有关,发病１周、２周、１个月、１个月以上疗效优良率分别为７２．２２％,６３．６４％,５０．００％,３３．３３％     

腰椎间盘突出症患者术前焦虑及影响因素研究

目的　探讨腰椎间盘突出症患者术前焦虑的发生情况及相关因素。方法　应用状态—特质焦虑问卷 (STAI)、社会支持评定量表 (SSRS)、生活事件量表 (L ES)等对 80例腰椎间盘突出症患者进行测查。结果　腰椎间盘突出症患者术前状态焦虑问卷 (S- AI)分值明显高于正常人群 (49.5 5± 8.18Vs39.31± 8.6 6 )。逐步回归分析发现 ,影响患者术前焦虑的主要因素为性格内向、社会支持状况差、负性生活事件多、担心手术效果不好、担心手术医生责任心不强等。结论　腰椎间盘突出症患者术前有明显的焦虑情绪 ,其发生受多种因素的影响。     

牵引推拿复位术治疗中央型腰椎间盘突出症的临床研究

通过对 5 6例中央型腰椎间盘突出症 6 2个椎间盘治疗前后的大小、形态量化的分析 ,认为牵引推拿复位术的作用机制是通过椎间盘的还纳和椎间盘的变形 ,改变了神经根与突出物的位置关系 ,松解粘连 ,解除压迫。对回纳变形机制进行了分析 ,认为要使椎间盘回纳 ,突出的髓核必须具有一定流动性 ,再借助完整的纤维和后纵韧带的张力及手法的压力 ,共同协调作用 ,方能实现。     

新型短节段内固定器治疗腰椎滑脱症的临床应用

目的：探讨新型短节段内固定器治疗腰椎滑脱症的临床应用价值。方法：对１８例腰椎滑脱的脊椎应用新型内固定器进行复位、固定,恢复脊椎的正常解剖结构,并自髂嵴后部取骨行横突间植骨融合。结果：术后随访１２￣２４个月,平均１８个月,滑脱复位率达９０％,４￣５月后达到骨性愈合,无螺钉松动,拨出,断裂及脊住骨滑脱现象。结论：新型短节段内固定器治疗腰椎滑脱症复位率高,固定螺钉松动,拨出,断裂及再滑脱等并发症少,疗效     

Posterior approach to the lumbar plexus combined with a sciatic nerve block using lidocaine

A combination of lumbar plexus block, by a posterior technique, and sciatic nerve block can be a useful technique for outpatient anaesthesia. The purpose of this study was to examine the clinical characteristics of these blocks using lidocaine and to measure the serum lidocaine concentrations. Forty-five patients, undergoing lower extremity surgery, were studied. Sciatic nerve and lumbar plexus blocks were made with lidocaine, 680 mg with adrenaline 0.3 mg. For each patient the following data were collected: weight, age, sex, site of surgery, time to perform each block, needle depth, speed of onset of the sensory and motor blocks in the territories of the sciatic, femoral, obturator and lateral cutaneous (sensory) nerves and postoperative analgesic requirements. Lidocaine serum concentrations were measured in ten of these patients at 0, 2, 5, 10, 30, 60, 90 and 120 min after the second block. Analgesia was complete in 88% (40/45) of the patients. The remaining five patients needed analgesics (fentanyl 150 μg or less). Despite the high dose of lidocaine, the serum concentrations were within safe limits (mean ± SD) (C_MAX = 3.66 ± 2.21 μg · ml^?1). Only one patient had a serum concentration > 5 μg · ml^?1 (C_MAX = 9.54 μg · ml^?1). This was associated with a contra-lateral extension of the block. We conclude that this combination of blocks is a valuable alternative for unilateral lower extremity anaesthesia. However, clinicians must be aware of the implications of a contra-lateral extension of the block.     

退变性腰椎管狭窄症手术治疗的探讨

目的：探讨退变性腰椎管狭窄症的手术治疗。方法：对９４例６０岁以上患者进行分型和手术治疗。结果：将本病分为Ⅰ型（侧隐窝狭窄型）;Ⅱ型（中央管狭窄型）;Ⅲ型（混合型）。对Ⅰ型手术方式采用单侧或双侧椎板开窗,扩大神经根管或（和）摘除髓核;对Ⅱ型行半椎板或全椎板切除术;对Ⅲ型行全椎板切除术。结论：通过术后疗效观察和３年随访,根据分型的不同选择不同的手术方式,可达到较好的临床疗效     

硬脊膜的蠕变率与椎间盘突出症的自然病程

目的　为探讨椎间盘突出症缓慢自愈的机理和治疗方法的选择提供一定的帮助。方法　应用２１ 例新鲜的猪的腰段硬脊膜,分组测量其蠕变率的变化。结果　各组蠕变率均与时间和载荷成正比,控温组发生速度快而大,模拟组发生慢而小。结论　蠕变率是椎间盘突出症症状缓解的力学基础,促进蠕变率发生的治疗,同减压治疗一样,都是病因治疗。     

节段内固定治疗腰椎峡部裂的生物力学研究

在8具成人新鲜腰椎标本上,通过脊柱三维运动实验机,研究了横突棘突钢丝捆绑法、钩螺钉固定法及Buck螺钉固定法对峡部裂腰椎三维稳定性的影响。实验结果表明：三者均能显著地恢复脊柱的稳定性,且三者之间无显著差别。     

Postoperative Pain Therapy After Lumbar Disc Surgery

Summary  Object. This study was undertaken to determine whether a special postoperative pain administration of tramadol and diclofenac provides any benefits in patients who underwent microsurgical lumbar discectomy.  Methods. The study consisted of 60 patients undergoing microsurgical lumbar discectomy. Patients were randomly divided into two groups based on the postoperative pain management: 1) Group A (n=30): no standardized pain therapy; these patients received on demand different analgesics and at variable dosages which were selected by the neurosurgeons; 2) Group B (n=30): standardized pain therapy with specific dosages of tramadol and diclofenac in regular time intervals during the first 48 hours after surgery. After surgery follow-up data from a special standardized questionnaire were obtained for all 60 patients during the first 48–72 postoperative hours. The patients were asked for course and intensity of pain as well as about some specific circumstances of clinical therapy after surgery.  The postoperative pain intensity of patients treated with the special combination of tramadol and diclofenac was significantly diminished (24 hours after surgery: p=0.0002, 48 h: p=0.0047, 72 h: p=0.0034) in relation to the group without standardized pain therapy. Similarly, the frequency of breakthrough pain was significantly reduced (24 h: p=0.0001, 48 h: p=0.003, 72 h: p=0.004).  Conclusions. The results suggest that the application of tramadol and diclofenac during the first 48 hours after lumbar microdiscectomy results in a reduction in postoperative pain without complications. We suggest that the use of this combination can be a beneficial adjunct to lumbar disc surgery.     

腰椎间盘突出症419例3种非手术疗法疗效分析

为比较下腰痛非手术疗效,４１９例腰椎间盘突出症患者采用腰椎牵引（甲组１９５例）、激素硬膜外注射（乙组１９２例）及经皮穿刺椎间盘切吸术或胶原酶溶解术（丙组３２例）进行治疗和随访,采用改良Ｍａｃｎａｂ标准评定。结果：优良率甲组４９％,乙组６６％,丙组８４％,Ｐ＜０．０１;甲组疗效与病程相关,病程＜６个月疗效较好（Ｐ＜０．０５）;平均治疗次数有甲组＞乙组＞丙组的倾向。结论：单纯腰椎牵引对病程较短者疗效较好;病程较长,神经根刺激症状明显者加用激素硬膜外注射可提高疗效;经腰牵、激素硬膜外注射等非手术治疗无效者,如严格掌握适应证和操作技术,采用经皮穿刺椎间盘切吸术或胶原酶溶解术可取得很好疗效