断端局部注射治疗骨折术后骨不连的疗效

目的探讨骨折断端局部注射金葡素注射液(简称金葡液)或金葡液联合自体红骨髓治疗骨折术后骨不连疗效。方法 112例术后骨不连患者中,89例骨折间隙≤5 mm患者在X线下取金葡液2 ml骨折处注射,每周1次,共6次; 23例5 mm 骨折间隙≤10 mm患者取金葡液2 ml联合自体红骨髓15～20 ml骨折处注射,自体红骨髓每月1次,共1～2次,金葡液2 ml每周1次,共6次。注射结束后1个月摄X线片复查,如骨折线模糊或消失视为治疗有效,骨折间隙仍清晰视为无效。治疗有效患者,继续观察,注射结束后3、6个月分别摄X线片评估骨折愈合时间及愈合状况;无效患者需针对骨不连的原因采取不同的手术干预措施。结果112例均获得随访,时间12～36个月。95例注射结束后1个月骨折线模糊或消失,3～5个月骨愈合,治愈率84. 8%; 17例治疗无效,再次采用植骨、更换或附加钢板固定治疗,术后5～8个月骨愈合。结论严格掌握适应证,采用骨折断端局部注射金葡液或金葡液联合自体红骨髓治疗骨折术后骨不连可促进骨愈合,该方法简单,临床疗效满意。     

36例长骨骨不连骨缺损的综合治疗

目的：探讨四肢长管状骨骨不连、骨缺损的治疗方法。方法：36例骨不连、骨缺损病人采用交锁髓内钉内固定，取自体髂骨植骨及术后经皮注射金葡液等综合治疗。结果：36例术后X线片显示，1个月骨折端周围出现骨痂，3个月有连续骨痂形成，6个月骨折愈合。无内固定物断裂、弯曲和松动，关节活动基本正常。结论：交锁髓内钉内固定、自体髂骨植骨及术后经皮注射金葡液综合治疗骨不连骨缺损，能提供坚强内固定，促进成骨活动，加快骨折愈合，是治疗长骨骨不连骨缺损的较好方法。     

金葡液局部注射治疗冻结肩28例

金葡液局部注射治疗冻结肩２８例上海市静安区中心医院（２００００４）包祖良，吴黎明，张晓珑，刘胜刚我们应用金葡液直接注射在冻结肩的主要病变区，辅以患肩在无痛范围内功能锻炼，疗效优于一般的传统疗法。现将我院于１９９４年１０月～１９９５年６月应用本疗法治疗...     

金葡液治疗骨不连36例分析

我科自１９９６年以来对３６例骨不连采用杭州第一生物化学制药厂生产的金葡液对骨折端注射治疗，效果良好。１　临床资料本组病例３６例，男２０例，女１６例。其中胫骨干骨折１８例，肱骨干骨折１４例，股骨干骨折４例。治疗前行切开复位内固定的病例２２例为Ａ组，手法复位石膏或夹板外固定的１１例为Ｂ组，牵引治疗的３例为Ｃ组。２　治疗方法对Ａ组病例，如内固定物尚牢固，单纯给予骨折端局部注射“金葡液”；如内固定物已松动或断裂，则取出之，不处理骨折端而给予外固定架加压固定，术后局注“金葡液”。对Ｂ组和Ｃ组病例，只要达到…     

“金葡液”治疗骨囊肿36例报告

采用“金葡液”腔内注射治疗骨囊肿36例,男性24例,女性12例,年龄在10～45岁之间。发病部位,肱骨近端24例,胫骨近端12例。全部病例均经X线及穿刺抽液化验确诊。首次注射药物做皮试。穿刺在X透视下进行。选取进针点两个,宜选在骨囊肿壁及软组织较薄且无重要神经血管部位。如骨壁较厚,先用克氏针凿透骨皮质,再进行穿针。两穿刺针针尖分别到达囊肿的两极,浅部针注入“金葡液”,注入同时可见深部针自动流出等量淡黄色液体,可用作化验。一般每次注入“金葡液”4ml,每周注射一次,一般4～6次即可。36例患者用药后均有局部疼     

综合治疗腰椎间盘突出症1912例回顾性分析

腰椎盘突出症是临床常见病多发病,此病复杂,治疗棘手,病情反复发作,患者痛苦是困扰患者的主要症状之一.腰椎间盘突出致病机制复杂,单一法的非手术治疗效果往往不令人满意.作者近一年来吸取多种单一法的非手术治疗效果的优点,采用硬膜外腔注射、骶管冲击疗法、侧隐窝注射疗法、椎旁注射疗法、按摩手法复位、牵引、中药内服外用的方法综合治疗腰椎间盘突出症,对1912例患者进行回顾性分析.     

注射型复合人工骨的研制与初步临床应用

对于骨不连的治疗,采用局部注射红骨髓或金葡液的方法,临床证实有一定疗效[1]。作者在成功研制复合珊瑚羟基磷灰石人工骨的基础上[2,3],改变使用复合人工骨的途径,解决临床骨不连问题,研制了该型人工骨,在2002年1月～2003年1月应用于临床6例,报告如下。1材料与方法将已经制备的     

医用臭氧联合类固醇激素治疗慢性腰椎间盘源性疼痛临床分析

目的 分析腰椎旁注射臭氧联合类固醇激素治疗慢性腰椎间盘源性疼痛的临床疗效.方法 慢性腰椎间盘源性疼痛患者120例,随机分为A组和B组.A组60例,注射类固醇激素混合液10 ml联合纯氧20 ml.B组60例,注射类固醇激素混合液10 ml联合注射30％浓度的医用臭氧20 ml.两组患者均给予腰椎椎旁阻滞,每隔1周注射1次,共治疗3次.观察两组患者治前,治疗后1周(短期)、3个月(中期)以及6个月(长期)疼痛VAS评分及Macnab疗效评价,评估各时间点两组患者的临床疗效.结果 两组VAS评分在治疗后1周、3个月、6个月与治疗前比较明显降低,两组治疗前后比较差异有统计学意义(P＜0.05);两组治疗后1周Macnab疗效评价比较差异无统计学意义(P＞0.05),治疗后3个月及6个月时比较,差异有统计学意义(P＜0.05),且B组优于A组.结论 腰椎旁注射臭氧联合类固醇激素治疗慢性腰椎间盘源性疼痛临床疗效显著,可作为慢性腰椎盘源性疼痛非手术治疗的方法.     

关节腔内注射消炎镇痛液复合玻璃酸钠治疗膝关节炎

目的：评价关节腔内注射消炎镇痛液复合玻璃酸钠治疗膝关节炎的疗效和安全性。方法：64＂ff~膝关节炎患者随机分为两组,对照组：口服双氯芬酸钠和氨基葡萄糖胶囊,治疗组关节腔内注射消炎镇痛液复合玻璃酸钠,共治疗4周;观察治疗前及治疗后1周、1个月和3个月的疼痛评分（VAS评分）、治疗效果以及不良反应。结果：两组VAS评分以及治疗效果均改善,治疗组总有效率明显提高（P〈0．05）。结论：关节腔内注射消炎镇痛液复合玻璃酸钠治疗膝关节炎是可行、安全、有效的方案,且无明显不良反应。     

CT引导下臭氧注射治疗腰椎间盘突出症

目的探讨CT引导下臭氧注射治疗腰椎间盘突出的价值。方法45例患者中椎间盘突出30例、椎间盘膨出15例,于CT引导下穿刺行臭氧注射治疗。穿刺途径:椎间盘突出为旁中央型者,经神经根与硬膜囊之间或神经根与小关节之间穿刺突出物达盘内;椎间盘膨出或后正中突出者则取脊柱中线旁开6~10 cm侧后方穿刺。分别于盘内及突出物中央和盘外注射浓度为40~50μg/ml臭氧5~15 ml,总量小于30 ml。结果注射臭氧后CT扫描显示臭氧在间盘内分布呈裂隙状、髓核腔内积聚状、弥散分布状及大部分溢出盘外状。治疗后3~6个月随访显效36例(80%)、有效6例(13%)、无效3例(7%),总有效率93%。结论CT引导下盘内、突出物及盘外臭氧注射术穿刺准确,可及时观察臭氧分布及注射后间盘的改变。它安全、创伤小、疗效高,是椎间盘突出症的理想治疗方法。     

Frequency and specific surgical management of far lateral lumbar disc herniations

Summary Frequency of Far Lateral Lumbar Disc Herniation The analysis of pre-operative computer-assisted tomograms and myelograms in a series of 694 operated lumbar disc herniations showed that a far lateral disc prolapse occured in 7% of the cases. Within the group of those far laterally herniated discs 3% of the herniations were predominantly located in the intervertebral foramen, whereas 4% of the protruded discs were mainly situated extraforaminally compressing the spinal nerve in its paravertebral course.Surgical Management of Extraforaminal Far Lateral Lumbar Disc Herniation By March 1988 40 patients had been operated on for an extraforaminal disc protrusion making use of an external microsurgical exposure (in two cases by a transmuscular approach and in 38 cases via an enlarged midline approach). A medium-term follow-up of these 40 patients revealed a substantial clinical relief of pain in 34 cases (85%). Based on these gratifying results we regard the external exposure of the extraforaminally protruded disc as the treatment of choice.     

IL-1β promotes disc degeneration and inflammation through direct injection of intervertebral disc in a rat lumbar disc herniation model

BACKGROUND CONTEXTLumbar intervertebral disc herniation (LDH) is a common disease that causes low back pain, radiating leg pain, and sensory impairment. Preclinical studies rely heavily upon standardized animal models of human diseases to predict clinical treatment efficacy and to identify and investigate potential adverse events in human subjects. The current method for making the LDH model involves harvesting the nucleus pulposus (NP) from autologous coccygeal discs and applying to the lumbar nerve roots just proximal to the corresponding dorsal root ganglion. However, this surgical method generates a model that exhibits very different characteristics of disc herniation than that observed in human.PURPOSETo produce a rat LDH model that better resembles disc herniation in humans and a standardized and uniform LDH model using Interleukin-1 beta (IL-1β).STUDY DESIGNExperimental rat LDH model.METHODSWe exposed the L5–6 disc dorsolaterally on the right side through hemi-laminectomy without nerve compression. Herniation was initiated by puncturing the exposed disc with a 30-gauge needle at a depth of 4 mm. Interleukin-1 beta (IL-1β) was injected simultaneously to heighten the pathological processes of disc degeneration, including inflammatory responses, matrix destruction, and herniation of the NP. We performed histological staining to assess morphological changes, immunohistochemistry to analyze inflammation- and pain-related expression within and around the puncture site of the L5–6 disc, and real-time polymerase chain reaction to examine expression of markers for degenerative processes. In addition, we performed locomotor tests on the rats.RESULTSWe found that the IL-1β groups showed that the border between the annulus fibrosis and nucleus pulposus was severely interrupted compared to that of the control (puncture only) group. And, the injection of IL-1β leads to accelerated disc degeneration and inflammation in a more consistent manner in LDH model. Functional deficit was consistently induced by puncturing and injection of IL-1β in the exposed disc.CONCLUSIONSThe method proposed here can be used as an index to control the severity of disc degeneration and inflammation through the injected IL-1β concentration concurrent with surgically induced herniation.CLINICAL SIGNIFICANCEOur proposed model may facilitate research in drug development to evaluate the efficacy of potential therapeutic agents for disc herniation and neuropathic pain and may also be used for nonclinical studies to more accurately assess the effectiveness of various treatment strategies according to the severity of disc degeneration.     

Herniation of a calcified nucleus pulposus in a child: case report

Herniation of the nucleus pulposus is a very rare complication of intervertebral disc calcification in children. We report a case in an 11-year-old girl. The majority of such cases should be treated conservatively as spontaneous resorption of the calcified lesion will occur.     

破裂型腰椎间盘突出的MRI表现及测量方法探讨

国内外学者认为,后纵韧带破裂是腰椎间盘突出后重吸收的关键因素。因此,对破裂型突出的影像学研究有着重要的临床意义。本文系统叙述了破裂型腰椎间盘突出症的MRI表现及其突出物大小测量方法,并对临床上常见的相关问题及解决方案进行了探讨。     

Serial changes in the rate of proteoglycan synthesis after chemonucleolysis of rabbit intervertebral discs.

STUDY DESIGN: Serial changes in the rate of proteoglycan synthesis in rabbit discs after chemonucleolytic treatment with chymopapain and chondroitinase ABC were measured using an in vitro method. OBJECTIVES: To determine the retained ability of the intervertebral disc to synthesize proteoglycans after chemonucleolytic treatment. SUMMARY OF BACKGROUND DATA: Most previous studies describe radiologic and histologic changes that occur after chemonucleolytic treatment. However, in humans it is not clear whether reconstitution of the disc space with normal nucleus proteoglycans can occur with time. METHODS: Twenty-five rabbits were treated with chymopapain (10 units/0.1 mL/disc) and chondroitinase ABC (5 units/0.1 mL/disc) by intradisc injection. Five rabbits were killed at each interval, 1, 2, 4, 8 and 12 weeks after injection. Radiologic changes in the disc height were noted, and the rate of proteoglycan synthesis was determined biochemically. RESULTS: After injection, no significant recovery of disc height was seen in either enzyme group after the initial disc narrowing. The average rate of proteoglycan synthesis in control rabbit intervertebral discs, those which had not been surgically treated, was 27.1 (x 10(-6) mmols sulphate/hour/dry weight). Twelve weeks after injection, the values were 21.6 in the saline group, 8.9 in the chondroitinase ABC group, and 8.2 in the chymopapain group. CONCLUSIONS: Doses within the therapeutic range can damage disc cells, at least in the rabbit, so that proteoglycan synthesis declined to 30% of control rates, and no significant recovery of disc height was observed.     

Intradiscal pressure-volume response: a methodological contribution to chemonucleolysis. Preliminary results

A new method is presented to verify whether a lumbar disc is degenerated prior to chemonucleolysis. This consists in rapid injection of a 0.3-ml bolus of saline into the center of the disc (through the needle employed for chemonucleolysis), under continuous recording of the intradiscal pressure changes caused by this volume load. If the intradiscal pressure falls below 600 mm Hg within 2 minutes after the injection, there is a high probability (p less than 0.001) that the disc is degenerated. This method has many advantages: it obviates additional injection of contrast medium prior to chemonucleolysis, it prevents inhibition of chymopapain by the contrast medium, it saves time, and it reduces the total amount of fluid injected during chemonucleolysis.     

重复注射胶原酶治疗腰椎间盘突出症

目的:探讨重复注射胶原酶治疗腰椎间盘突出症的疗效及安全性。方法:经过注射胶原酶治疗效果不理想的腰椎间盘突出症患者58例,重复注射胶原酶,观察疗效及影像学变化。L4,527例L5S131例;年龄20~61岁,平均42岁;男25例,女33例;病程2个月~5年,平均3·7个月。第1次注射到本次注射的时间平均为3·8个月。结果:根据疗效评价标准优46例,良5例,可2例,差5例。46例症状体征消失,患者术后1个月复查CT,原突出的椎间盘缩小2~6mm,平均3·4mm;余12例效果不理想的患者,术后1周复查CT,7例突出的椎间盘较术前大,5例椎间盘形态、体积无改变。此12例第3次溶盘术后其中10例症状体征消失,2例症状体征有所改善,其中1例行第4次溶盘术后症状进一步改善。27例CT显示有椎间盘出现真空征。复查CT突出的椎间盘溶解率73%,未发生过敏、感染、破坏、椎体滑脱等情况。结论:注射胶原酶治疗腰椎间盘突出症可以重复进行,适应证选择恰当可以彻底治愈此病,并且有较高的安全性。     

自制颈腰牵引器治疗腰椎间盘突出症疗效观察

目的 探讨自行研制的一种颈腰牵引器对腰椎间盘突出症的临床疗效.方法 选择42例年龄在38～60岁的中老年腰椎间盘突出患者试用,观察牵引前后患者症状改变.结果 本组42例病例均获得随访,以1994年中华医学会脊柱学组腰背疼痛非手术评价标准为参考,治愈为29例,有效9例,无效4例,有效率为90.5％.9例下肢放射痛患者4例不能耐受牵引,而行手术治疗.结论 自行研制的颈腰牵引器具有结构简单、经济实用、重量轻、可折叠、便于携带、使用移动存放方便等优点,对腰椎间盘突出症患者有较好的治疗效果.     

Evaluation of thiol-modified hyaluronan and elastin-like polypeptide composite augmentation in early-stage disc degeneration: comparing 2 minimally invasive techniques

STUDY DESIGN.: An in vitro biomechanical and imaging study generated from an in vivo porcine model of early stage degenerative disc disease was used to evaluate mechanical property restoration, comparing 2 minimally invasive injection techniques. OBJECTIVE.: To evaluate the ability of an injectable hydrogel to restore the mechanical properties of spinal motion segments with early stage disc degeneration, comparing 2 minimally invasive injection techniques. SUMMARY OF BACKGROUND DATA.: Treatment of early-stage disc degeneration may benefit from a combination of tissue engineering and minimally invasive therapeutic approaches. A recently developed hydrogel, thiol-modified hyaluronan elastin-like polypeptide (TMHA/EP) composite, has demonstrated potential as an injectable nucleus replacement. METHODS.: From a total of thirteen 35-kg Yorkshire boars, early-stage lumbar disc degeneration was introduced into 10 pigs via injection of chondroitinase ABC. After degeneration, 8 pigs received TMHA/EP augmentation; 1 disc via direct needle injection and a second using a modified kyphoplasty approach. High-resolution magnetic resonance images were acquired of the excised spinal motion segments, followed by biomechanical testing in axial compression, flexion-extension, lateral bending, and torsion. RESULTS.: The degenerate control motion segments were generally less stiff and more flexible than healthy controls. The injection of TMHA/EP into the degenerated nucleus produced similar mechanical stiffness to healthy controls. The direct-injected discs showed a dispersive pattern of TMHA/EP within the nucleus, whereas the modified kyphoplasty method yielded a bolus of hydrogel. Yet, mechanical behavior was comparable considering the 2 minimally invasive augmentation techniques. CONCLUSION.: The TMHA/EP composite can restore initial mechanical behavior in early-stage disc degeneration. Although both augmentation methods yielded mechanical properties comparable with healthy controls, direct injection represents a simpler technique, uses a smaller-gauge needle, does not introduce air into the disc, and yields a dispersive pattern that may be beneficial for future delivery of cells or growth factors.     

Two-level thoracic disc herniation

Herniation of thoracic discs at T6-7 and T7-8 occurred in a 41-year-old man. Thoracic disc disease is rare and the present case could be the first two-level herniation reported in the literature. The diagnosis was established by a myelogram (metrizamide) and computed tomographic (CT) scanning. The herniated discs were excised through a posterolateral approach. The preferred exposure is either translateral or transthoracic. Laminectomy is contraindicated, as it fails to correct spinal cord hemodynamics or relieve axial tension in the presence of an anterior epidural obstruction.