青少年腰椎间盘突出症手术治疗

目的探讨青少年腰椎间盘突出症的临床特点、治疗方法及效果。方法21例青少年腰椎间盘突出症患者均行手术椎板开窗髓核摘除，对其进行回顾性分析。结果所有病例均得到随访，平均随访时间18个月，优良率100％。结论创伤和先天发育畸形是造成青少年腰椎间盘突出症的主要原因。     

青少年腰椎间盘突出症的病因及治疗

目的 :探讨青少年腰椎间盘突出症的病因和治疗。方法 :12例青少年腰椎间盘突出症均手术治疗 ,开窗术 9例 ,扩大开窗 3例 ,分析其病因 ,临床表现及治疗方法。结果 :随访全部病例 ,平均随访时间 1 5年 ,优良率达 92 3 %。结论 :外伤和畸形是造成青少年腰椎间盘突出症的主要原因 ;X线检查不易诊断和定位 ,体征明显是其临床特征。治疗上在严格保守治疗无效的情况下 ,手术治疗也是重要的治疗方法。     

青少年腰椎间盘切除术后的中远期疗效观察

青少年腰椎间盘突出症在临床上不常见,1945年Wahren首次对其描述以来,在关于青少年患者一系列手术治疗的报道中,大多数的结果不尽相同,而且长期随访的结果也是各异的。出现上述情况，是手术治疗的方法没有被标准化引起的。本文回顾性研究1990年至2004年24例在我院行外科手术治疗的青少年腰椎间盘突出症患者，以此评价青少年患者腰椎间盘切除术后的中远期疗效。     

青少年腰椎间盘突出的诊断与治疗

腰椎间盘突出症在成人是一种常见病，而对于青少年，临床少见，但据观察，近年来青少年腰椎间盘突出症的发病率有上升的趋势；青少年腰椎间盘突出症的临床表现与成人不尽相同，一般的临床检查和普通的X线片不易确诊，在发病原因和治疗方法的选择上存在争议。自2000年以来我院共诊治青少年腰椎间盘突出症15例，本文就其发病原因，临床表现及治疗方法的选择进行回顾性分析。     

儿童及青少年腰椎间盘突出症101例手术治疗长期随访报告

儿童及青少年腰椎间盘突出症１０１例手术治疗长期随访报告程迅生摘译作者复习了１０１例经手术治疗的儿童及青少年腰椎间盘突出症，最显著的病因及病理因素为椎间盘退变的过早出现。先天性腰骶畸形和反复创伤。主要的临床症是疼痛，常常为坐骨神经痛，而体征不如成人常见...     

青少年腰椎间盘突出症研究现状及进展

青少年正处于发育阶段 ,其发生腰椎间盘突出症的发病机理、临床表现与成人有明显区别 ,临床上易延误诊断。为此 ,本文着重对青少年腰椎间盘突出症的发病机理、临床特点、治疗进展进行阐述。结果表明青少年腰椎间盘突出症发病率低 ,为 0 .4% -6% ,临床表现与成年人有很大差异。在诊断上 ,体征、影像学改变比症状可靠 ;治疗上先采用非手术治疗 ,如效果不佳 ,则早期手术 ,长期随访疗法满意     

椎间盘镜治疗青少年腰椎间盘突出症

目的探讨青少年腰椎间盘突出症发病机理、临床特点及治疗方法。方法采用微创外科技术椎间盘镜行腰椎间盘突出症髓核摘除术及术后系统康复治疗。结果本组25例,随访13—36月,按Nakai分级：优23例,良1例,可1例,优良率96％：25名青少年术后3个月均恢复正常生活和学习：结论青少年腰椎问盘突出症经3个月正规保守治疗无效后应尽早手术治疗,微创手术是治疗青少年腰椎间盘突出症的首选的手术方法：特别强调术后系统康复治疗,促进青少年病人早日康复。     

青少年腰椎间盘突出症

目的：探讨青少年腰椎间盘突出症的病因和治疗。方法：１３例青少年腰椎间盘突出症均手术治疗,开窗术９例,半椎切除３例,全椎板切除术１例;并分析其病因,临床表现及治疗方法。结果;随访全部病例,平均随访时间４．２的,优良率达９２．３％。结论：外伤和畸形是造成青少年腰椎间盘突出症的主要原因;症状轻,体征明显是其临床特征     

经皮穿刺切吸治疗青少年腰椎间盘突出症

目的　探讨青少年腰椎间盘突出症的临床表现和治疗。方法　 7例青少年腰椎间盘突出症均行经皮穿刺切吸治疗 ,并分析临床表现和治疗方法。结果　随访全部病例 ,平均随访 2 .8年 ,症状体征均消失。结论　临床表现特点为症状轻 ,体征重 ;治疗上不要过分强调保守治疗 ,经皮穿刺切吸是重要的治疗方法之一。     

青少年腰椎间盘突出症的诊治分析

目的　探讨青少年腰椎间盘突出症的诊治方法。方法　回顾性分析2 3例青少年腰椎间盘突出症,保守治疗7例,其中3例改手术治疗;手术治疗共19例,其中椎间盘镜髓核摘除术9例,开窗术5例,半椎板切除3例,全椎板切除术2例。结果　随访全部病例,平均随访时间5 .8年,优良率达95 .6%。结论　外伤是造成青少年腰椎间盘突出的主要原因;其临床特征是症状轻,体征明显;临床上应有保持脊柱稳定性的前提下达到临床疗效的思维,选择最适合患者的治疗方法治疗青少年腰椎间盘突出症。     

Mid- to long-term outcome of disc excision in adolescent disc herniation.

BACKGROUND CONTEXT: Adolescent disc herniation and its surgical treatment have been the subjects of many published clinical series. The majority of these series were heterogeneous; the number of adolescent patients (12-17 years) as opposed to young adults (18-20 years) was generally small and the length of follow-up varied greatly. Although the short-term outcome of disc excision in adolescents was mostly favorable, their long-term outcome is unknown. OBJECTIVES: To evaluate the mid- and long-term results of discectomy in patients younger than 17 years of age. STUDY DESIGN: Retrospective examination of a series of adolescent patients under the age of 17 years who underwent surgery for lumbar intervertebral disc herniation. PATIENT SAMPLE: The medical records of 26 patients (15 males, 11 females, 12-17 years old [average 14.6]) who were operated for lumbar intervertebral disc herniation in three spine centers between 1984 and 2002 were reviewed. These subjects represented the total number of patients meeting the criteria of adolescents undergoing discectomy for lumbar disc herniation in these institutions during the study period. All patients were located and contacted by an independent observer not involved in the care of these patients. Low back pain associated with leg pain was the main clinical symptom in 20 patients (77%), leg pain in 4 (15%), and back pain in 2 (8%). They all underwent posterior disc excision: 23 (88%) patients had one level discectomy, and 3 (12%) had simultaneous discectomy at two levels. The L4-L5 interspace was involved 19 times, and the L5-S1 interspace 10 times. Slipped vertebral apophysis was diagnosed in 4 patients (15%). Twelve of the 26 patients (46%) had a first-degree relative with a history of lumbar disc herniation. OUTCOME MEASURES: Telephone interviews provided follow-up data for 26 patients. Results were classified as excellent, good, moderate, or poor according to current symptom status, the need for additional surgery, the Oswestry Disability Index, and back and leg pain scores. RESULTS: The average time from surgery to follow-up was 8.9 years (range 3-21 years). At follow-up, the clinical results were excellent in 13 patients (50%), good in 4 (15%), moderate in 8 (31%), and poor in 1 (4%). Four subjects (15%) underwent a subsequent disc excision in the lumbar region, and one of them later underwent fusion. CONCLUSIONS: Discectomy provides satisfactory clinical results in young patients with disc herniation. The rate of reintervention (15%) is comparable to that in adults, indicating that discectomy for young patients should be approached similarly to that in adults.     

Adolescent disc protrusions

Summary The management of adolescent disc protrusions by chemonucleolysis has received little attention in the literature, and reports of the long-term outcome are lacking. Between May 1978 and July 1986 42 patients between the ages of 13 and 19 years with radiologically proven lumbar disc protrusions were treated at this institution with chymopapain. They were followed prospectively for 1 year, and the procedure was successful in 27 patients (64%). Of the 15 patients in whom the treatment failed, 11 underwent subsequent surgical discectomy, successful in 10, giving an overall treatment success rate of 37/42 (88%) at 1 year. The patients were contacted by telephone and questionnaire at a minimum of 5 years after treatment (mean 8.5 years), and full replies were obtained from 39/42 (93%). The long-term outcome was good or excellent in 82%. A history of injury, and the demonstration by MRI or discography of disc degeneration at more than one level was associated with a reduced success rate both at 1 year and in the long term. We conclude that there are no long-term ill effects of chemonucleolysis with chymopapain on the adolescent disc. It is a useful procedure that is well tolerated and we have no reservations about its use.     

腰椎间盘突出症术后下腰痛及再突出的临床分析

[目的]探讨腰椎间盘摘除术后下腰痛以及腰椎间盘再突出的情况。[方法]在采用后路腰椎板开窗突出椎间盘摘除手术的患者中，随机选择200例，对其中获得5a以上随访的84例患者进行回顾性分析，对手术前后下腰痛JOA评分以及影像学结果进行统计处理。[结果]（1）79．8％的患者残留下腰痛，其中14．3％患者存在严重的下腰痛（JOA 1），75％的严重下腰痛患者在35岁以下；（2）13例患者行二次手术，其中12例为腰椎间盘再突出，1例为腰椎不稳，13例患者中主要是50岁以下的成年男性。[结论]年轻患者更易发生严重的下腰痛以及腰椎间盘再突出，在年轻患者首次手术时可以根据情况适当考虑脊柱融合。     

Posterior releasing techniques for idiopathic scoliosis: microscopic discectomy and transverse process resection: a technical note

The authors describe techniques and preliminary results of two releasing procedures for idiopathic scoliosis, which can be performed concomitantly in the same stage of posterior instrumentation surgery. The transpedicular microscopic discectomy and transverse process resection were clinically applied for adolescent idiopathic scoliosis. Twelve patients were divided into three groups at random: Group A patients underwent no release, group B patients underwent transverse process resection, and group C patients underwent microscopic discectomy of three discs and transverse process resection, in combination. All patients were operated on with derotation procedure with Cotrel-Dubousset instrumentation simultaneously after each releasing procedure. The outcomes-curve correction, disc wedge angle, and rotational changes-were evaluated 12 months postoperatively. The mean correction rate of the Cobb angle in group C (78%) was higher than in groups A (54%) and B (64%). Correction of the disc wedge angle was also higher in group C compared with groups A and B. The authors conclude that microscopic discectomy appeared to be an effective releasing method for thoracic curve and that further investigation is necessary for accurate evaluation of the transverse process resection.     

Early risk factors for lumbar discectomy: an 11-year follow-up of 57,408 adolescents

There is a lack of longitudinal studies on the risk factors of lumbar discectomy. Using combined population survey and hospital discharge register data in a prospective longitudinal design, we investigated the association between adolescent risk factors and lumbar discectomy until early middle age. A prospective cohort of health survey respondents (n = 57,408) aged 14–18 years was followed for 651,000 person-years (average follow-up, 11.3 years). Study endpoints were lumbar discectomy, death or end of follow-up. Participants’ mean age at the end of follow-up was 27 years. In multivariate Cox’s regression analysis, the significant risk factor for lumbar discectomy among male respondents was daily smoking, HR being 1.5 (95% CI 1.1–2.2). In females, frequent participation in sports clubs (HR 2.7, 95% CI 1.1–6.3) and overweight (HR 2.1; 95% CI 1.1–4.1) were significantly associated with an increased risk of lumbar discectomy. Daily smoking in males and frequent participation in sports clubs and overweight in females measured at adolescence were statistically associated with lumbar discectomy at an 11-year follow-up, although the hazard ratios were relatively small. Further study of these common risk factors and their modifications may lead to a better understanding of the causes of lumbar disc herniation.     

Extraperitoneal anterolateral discectomy for lumbar disc herniation: indications, techniques, and time-related clinical results.

We analyzed 80 consecutive cases of lumbar disc herniation who underwent an extraperitoneal anterolateral discectomy according to clinical and radiologic parameters. The average follow-up period was 5 1/2 years (range, 1-10 years). The results of 71 patients (89%) were satisfactory through the mid- and long-term follow-up periods, although a very slight decrease in subjective/objective scores and ADL score was found. Satisfactory results were obtained for adolescent and younger male adults and in isolated central or centrolateral herniations with a broad base. From an analysis of the nine reoperated cases, we determined that the contraindications of this technique are a sequestrated or extruded nucleus pulposus and disc protrusion accompanied by posterior dislocation of a vertebral edge fragment. The relative indications include a small, hard posterolateral herniation located just beneath the nerve roots, double-level herniation, disc herniation accompanied by narrow spinal canal, and bulged disc in elder patients. The absolute indications for this surgery are a centrally or centrolaterally protruded disc with a relatively broad base of herniation at single-disc level that is not accompanied by spinal stenosis in adolescent and younger male adults.     

CHILDREN OR YOUNG ADULTS? A POPULATION‐BASED STUDY ON ADOLESCENT HEAD INJURY

BACKGROUND: The aim was to study the epidemiology of significant adolescent head injury in a statewide population. METHODS: A retrospective review of all significant adolescent (12-19 years old) head injuries over a period of 3 years was undertaken and compared with those of children (0-11 years old) and young adults (20-29 years old). RESULTS: The incidence of significant adolescent head injury was 19.2 per 100,000 adolescents per year. This compared to the incidence in children of 12.9 per 100,000 and in young adult of 14.7 per 100,000. Of all significant adolescent head injuries, 63.9% are managed at adult trauma centres. Demographics, pathology, neurosurgical management, length of intensive care unit stay, ventilated hours and length of hospital stay were similar to those of young adults and significantly different from those of children. Prehospital predictors of mortality were similar across all groups. Adolescent discharge destinations were similar to those of young adults and significantly different from those of children. CONCLUSIONS: The study emphasizes the incidence of and mortality from adolescent head injury. The pattern of adolescent head injury is different from that of children and supports current practice of treatment of a majority of adolescents in adult trauma centres. These differences have implications on planning for injury prevention and trauma management.     

经皮内窥镜下腰椎椎间盘切除术与椎板开窗椎间盘切除术治疗青少年腰椎椎间盘突出症

目的　比较经皮内窥镜下腰椎椎间盘切除术(PELD)与椎板开窗椎间盘切除术治疗青少年腰椎椎间盘突出症(LDH)的临床疗效。方法 2012年1月—2016年12月,海军军医大学附属长征医院收治青少年LDH患者82例,其中40例(A组)采用PELD治疗,42例(B组)采用椎板开窗椎间盘切除术治疗。记录并比较2组患者手术时间、术中出血量、术后卧床时间、咬骨体积,以及术前、术后1个月和末次随访时疼痛视觉模拟量表(VAS)评分、Oswestry功能障碍指数(ODI)。结果所有手术顺利完成,所有患者随访12个月。A组手术时间、术中出血量、术后卧床时间及咬骨体积均低于B组,差异有统计学意义(P 0.05)。2组患者术后VAS评分和ODI均较术前明显改善,差异有统计学意义(P 0.05);组间比较术后VAS评分和ODI,差异均无统计学意义(P 0.05)。末次随访时MacNab疗效评定优良率A组为92.50%(37/40),B组为90.48%(38/42),差异无统计学意义(P 0.05)。A组并发症发生率为5.0%(2/40),B组为7.1%(3/42),差异无统计学差异(P 0.05)。结论 PELD可取得与传统椎板开窗椎间盘切除术相近的临床疗效,且可降低出血量,减少骨性结构破坏,缩短患者术后卧床及康复时间,是较为理想的治疗青少年LDH的微创方法。     

Comparison of postural control in unilateral stance between healthy controls and lumbar discectomy patients with and without pain

Main problem: Previous studies have demonstrated that sciatica patients have poorer postural control than healthy controls and that postural control remains unchanged 3 months after lumbar discectomy in sciatica patients. The aims of the current study were to investigate whether static balance control recovers in pain-free discectomy patients long-term after lumbar discectomy. Next is to determine whether static balance responses of asymptomatic and symptomatic lumbar discectomy patients differed from each other and from healthy controls. In addition, the influence of the extent of disc resection (unilateral/bilateral removal) and the side of operation on static balance control were investigated. Methods: Fifteen pain-free lumbar discectomy patients, 23 lumbar discectomy patients with residual pain and 72 controls performed unilateral stance tasks with eyes open and eyes closed on a force plate were taken up for the investigation. Three repetitions of a 10 s unilateral stance test were performed on each leg. Postural sway was determined. Patients were divided into three age groups. Results: In the eyes open condition, there was no significant difference between postural sway of pain-free lumbar discectomy patients and controls (P=0.68), whereas balance of patients with pain was significantly worse than in controls (P=0.003). In the eyes closed condition, the sway in both groups of lumbar discectomy patients was significantly worse than in controls (pain-free P=0.009/painful P<0.001). No significant differences were found in postural sway between patients with unilateral and bilateral disc resection. In unilateral stance on the leg of the operated side, centre of gravity sway was not significantly different in the eyes open condition compared to the eyes closed condition, whereas in stance on the leg of the non-operated side, postural sway was significantly lower in the eyes open condition compared to the eyes closed condition. In both conditions, postural sway in the age group of 50–65 years was significantly higher than in the age groups of 30–39 years (eyes open P=0.005; eyes closed P<0.001) and 40–49 years (eyes open P=0.002; eyes closed P=0.006). There was no significant difference between the age group of 30–39 years and the age group of 40–49 years (P=0.51). Conclusion: As for long-term following lumbar discectomy, there is no complete recovery of postural control. Patients seem to develop visual compensation mechanisms for underlying sensory–motor deficits, which are, however, sufficient in case of pain relief only. Further study is needed to determine the cause of the balance disturbances in lumbar discectomy patients.     

不同术式治疗腰椎间盘突出症的中长期疗效分析

目的 探讨4种不同方法治疗腰椎间盘突出症的中长期疗效.方法 对440例腰椎间盘突出症患者行后路开窗减压髓核摘除(A组,178例)、半椎板切除(B组,122例)、全椎板切除(C组,66例)及上述3种术式加后路椎弓根螺钉系统内固定(D组,74例)治疗.术后随访30～66个月,平均49个月.获得随访病例,男245例,年龄19～72岁,平均(43.36±11.64)岁,病程3 d～18年;女195例,年龄20～76岁,平均(43.78±12.09)岁,病程7 d～20年.对临床资料进行回顾性分析,按照Oswestry 功能障碍指数(Oswestry disability index,ODI)设计问卷随访,对不同术式腰椎间盘突出症临床效果进行评分并行统计学分析.结果 4种术式总体优良率分别为88.76%、83.61%、77.27%、90.54%,D组与A、B组比较疗效差异无统计学意义(P＞0.05),D组与C组比较疗效差异有统计学意义(P＜0.05);A、B、C、D组单节段优良率分别为89.93%、85.58%、78.57%与90.77%,双节段优良率分别为81.48%、76.47%、70.00%与87.50%,内固定组与非内固定组疗效差异均无统计学意义(P＞0.05).结论 传统经典手术加后路内固定为腰椎间盘突出症手术彻底减压融合创造良好条件,但无论是单节段或双节段病变,加后路内固定都不能显著提高临床疗效.传统经典手术仍是治疗腰椎间盘突出症的安全、有效方法.