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颈、肩、腰、腿疼痛患暑的临床治疗效果.方法:选择67 例年龄在18-70岁的腰椎间盘突出患者试用,观察牵引前后患者症状及体征改变.结果:本组67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,其中显效为49例,有效13例,无效5例,无不良反应.有效率为92.5%,结论:自行研制的颈腰牵引器具有结构简单、经济实用,便于携带,使用方便,可同步拉伸牵引颈腰部等优点,对腰椎间盘突出症患者有较好的治疗效果.     

腰椎间盘突出症的牵引复位治疗

目的　探讨利用牵引复位法治疗腰椎间盘突出症。方法　 1991年 7月～ 2 0 0 1年 5月对5 6 0例腰椎间盘突出症 (L4,5、L5,S1 )患者中的 35 0例采用牵引复位治疗 ,经 6月～ 3年对其中的315例随访观察疗效。结果　牵引复位法治疗腰椎间盘突出症 ,优良率 90 .6 %。结论　牵引复位法对腰椎间盘突出症的治疗确实有良好的疗效。     

手法结合牵引、药熏治疗腰椎间盘突出症规范化研究

目的 评价施氏伤科脊柱整骨手法结合电动牵引床牵引和舒筋活血散熏蒸治疗腰椎间盘突出症的临床疗效.方法 将117例符合入组标准的患者按照随机、对照的原则进行分组,治疗组为施氏伤科脊柱整骨手法结合电动牵引床牵引和舒筋活血散熏蒸治疗;对照组为舒腰灵冲剂结合牵引和舒筋活血散熏蒸治疗,应用VAS、M-JOA、LMA、SLR及分级疗效评定进行治疗前后疗效评价.结果 治疗组在VAS、M-JOA、LMA分级疗效评定上明显优于对照组,两组差异有统计学意义.结论 施氏伤科脊柱整骨手法结合电动牵引床牵引和舒筋活血散熏蒸治疗腰椎间盘突出症疗效突出、确实有效、可以做为保守治疗腰椎间盘突出症的规范化方案推广应用.     

颈椎间盘突出症合并腰椎间盘突出症的非手术治疗

目的：研究非手术治疗颈椎间盘同症合江腰椎间盘同症的疗效。方法：核计从１９９０．２至１９９８．２,住院患者中颈椎间估出症合交腰椎间盘突出症５５例,同期颈椎间突出症３５７例,腰椎间盘突出症５８９例,分别占１５．４１％和９．３４％,优良率为８０％。而且作者描述了该疾病的症状、体征、非手术治疗的方法,同时介绍了牵引、推拿的注意事项。结论：非手术治疗（包括干扰素治疗）颈椎间盘突出症合并腰椎间盘突出症是有效的     

脊柱减压牵引治疗腰椎间盘突出症

目的：探讨脊柱减压牵引治疗腰椎间盘突出症的临床效果。方法将甘肃省张掖市人民医院2012年5月至2013年1月收治的符合病例选择标准的30例椎间盘突出症患者,采用随机数字表法分为脊柱减压牵引组（试验组,n=15）和腰牵引组（对照组,n=15）。两组患者性别分布、年龄、椎间盘突出类型及部位比较,差异均无统计学意义（P＞0.05）。先予超短波治疗;然后试验组进行脊柱减压牵引,对照组采用腰牵引治疗;最后两组均予动态干扰电治疗。比较两组直腿抬高角度、视觉模拟量表（VAS）评分及总有效例数的差异。结果治疗后两组直腿抬高角度及VAS评分均较治疗前有明显改善（P＜0.05）,试验组优于对照组。试验组治愈8例、显效4例、有效2例、无效1例;对照组治愈4例、显效2例、有效3例、无效6例。试验组总有效例数高于对照组（P＜0.05）。结论脊柱减压牵引治疗腰椎间盘突出症可有效缓解患者腰部疼痛感,改善患者生活及行动能力,疗效满意。     

胶原酶溶解术治疗椎间盘突出疗效及不良反应

目的 评价胶原酶治疗椎间盘突出症的疗效及不良反应。方法 采用颈椎硬膜外置管、腰椎间孔硬膜外、Ls-S1侧隐窝硬膜外前间隙胶原酶注射治疗颈、腰椎间盘突出症652例。结果 胶原酶溶解术治疗颈及腰椎间盘突出症有效率为92．3％、90．3％，主要不良反应为疼痛加剧、过敏反应、脊髓损伤、腰麻等。结论 胶原酶溶解术治疗腰及颈椎间盘突出症见效快、疗效较高、创伤小、操作简单。     

腰椎间盘突出症的一种新的物理学检查方法

目的 通过临床实践创新,在原有多种物理学检查的基础上,增加一种腰椎间盘突出症物理学检查的体征,提高腰椎间盘突出症的诊断率,探索一种诊断方法.方法门诊随机抽取97例腰椎间盘突出症患者(经腰椎正侧位X线片、CT检查诊断明确),均行屈颈实验、屈颈屈腰实验两种物理学检查,比较两种体征的阳性率.结果屈颈屈腰试验阳性率为97.91%.屈颈试验阳性率为11.46%.两种检查的阳性率经过卡方检验,P<0.01,有显著性差异.结论屈颈屈腰试验明显提高了腰椎间盘突出症的物理学检查阳性率,从而提高了诊断率,是腰椎间盘突出症的一种较有意义的新物理学检查方法,值得临床推广应用.     

腰椎间盘突出症手法治疗后腰部软组织张力变化研究

目的观察腰椎间盘突出症患者不同治疗方法后腰部的软组织张力变化,探讨其可能的机制及应用价值。方法选取腰椎间盘突出症患者60例,按干预手段随机分为手法组和牵引组,每组30例,通过测量软组织张力值证实软组织张力在腰椎间盘突出症患者治疗前后的变化。结果手法组软组织张力改善(P<0.01),牵引组软组织张力减退(P<0.05)。说明推拿手法对软组织张力改善有显著作用,但其影响过程非线性,呈反复渐进模式。牵引则无改善作用或加重其减退。结论软组织张力增高与疼痛相关,其变化可以作为反映腰突症病情的指标。以推拿手法为代表的复合治疗方法有助于缓解疼痛所引起的肌痉挛和软组织紧张。     

臭氧注射与牵引治疗腰椎间盘突出症的比较

目的考察臭氧椎间盘内注射在治疗腰椎间盘突出症上同腰椎牵引法之间疗效的差别,以确定对该病治疗的最佳方案。方法回顾性分析自2010年3月至2013年3月门诊收治或住院治疗的腰椎间盘突出症患者共计92例,其中男49例,女43例;年龄20~76岁,平均45.2岁。病例被随机分为臭氧治疗组(50例)及对照组(42例),其中臭氧治疗组以臭氧椎间盘内注射的方式进行腰椎间盘突出症的治疗,而对照组则以传统腰椎牵引治疗。根据两组患者治疗前后的临床情况,评估不同方法对于该病的治疗效果,疗效评价依据MacNab腰腿痛手术评价标准评价。结果经过一个疗程的治疗,两者的腰椎间盘突出症的症状均有一定程度的改善。组间治疗效果对比,臭氧治疗组有效率为94.0%,对照组有效率为47.6%。臭氧治疗相对于传统的腰椎牵引法有显著性的区别。结论臭氧椎间盘内注射治疗腰椎间盘突出症有很好的临床疗效,是一种安全、有效、微创的方法。     

减少腰椎间盘突出症手术出血的体会

自1987年1月至1989年12月共手术治疗腰椎间盘突出症150例,对术中及术后出血相对较多的15例讨论如下。 一般资料 15例中男8例、女7例;年龄32～63岁,平均40岁。有外伤史7例;病变部位:腰_4.5椎间盘突出11例;腰_5骶_1椎间盘突出4例。上述病例均有典型的腰椎间盘突出症表现,且经保守治疗,牵引等无效,后经X线片及CT检查确诊者。     

等离子射频髓核成形术治疗腰椎间盘突出症

目的探讨应用等离子射频髓核成形术治疗腰椎间盘突出症的疗效。方法应用等离子手术系统治疗腰椎间盘突出症40例，先行椎间盘造影，阳性后行等离子射频髓核成形术。结果40例44个椎间隙穿刺均顺利。40例随访2～8个月，平均5个月，参照13本Nakano腰背痛手术评定标准，优8例，良29例，优良率92％（37／40），其中中央型优良率80％（8／10），单侧型97％（29／30）。未发生并发症。结论等离子射频髓核成形术是治疗腰椎间盘突出症的一种简单、安全、有效的微创手术。     

游离型腰椎间盘突出症的手术治疗

目的评价游离髓核摘除术治疗游离型腰椎间盘突出症的疗效。方法 2003年1月至2009年12月采用游离髓核摘除术治疗游离型腰椎间盘突出症69例,获得完整随访资料者58例,其中男31例,女27例,年龄19～54岁,平均38.5岁。L3～4椎间盘突出3例,L4～5椎间盘突出29例,L5S1椎间盘突出26例。根据游离髓核的位置,分别采用扩大开窗、半椎板切除和全椎板切除,摘除游离髓核,研究其发病情况、临床症状、体征、影像学表现、手术方法、术中发现及治疗效果。结果随访时间1～6年,平均3.5年,平均手术时间(1.0±0.2)h,平均出血量(280±25)mL。硬脊膜撕破8例,一过性单侧神经根麻痹2例。末次随访复发2例,58例患者按Nakai标准评定疗效,优24例,良27例,可5例,差2例,优良率87.9%。结论彻底摘除游离髓核是治疗游离型椎间盘突出症的较好方法。     

破裂型腰椎间盘突出症的手术治疗

目的评价破裂型腰椎间盘突出症的手术治疗效果。方法回顾性研究1999年1月至2006年1月手术治疗48例破裂型腰椎间盘突出症患者的临床症状、体征、影像学表现及治疗效果。结果48例术前均明确诊断并及时进行了椎间盘切除术,术后随访1~7年,平均3.1年,按Nakai标准判定,优30例,良15例,可3例,优良率93.7%。结论破裂型腰椎间盘突出症术前即可明确诊断,应尽早手术治疗,疗效满意。     

破碎型腰椎间盘疝出和退变型腰椎间盘突出的X线及MRI表现

目的：探讨破碎型腰椎间盘疝出和退变型腰椎间盘突出的X线及MRI表现。方法：回顾性分析110例腰椎间盘突出症,依术中所见分为两组：破碎型腰椎间盘疝出组和退变型腰椎间盘突出组,比较两者的X线及MRI表现。结果：72例破碎型椎间盘疝出组有48例椎体骨质增生,21例病变节段椎间盘内低信号,5例出现椎间盘上下终板信号异常,35例病变椎间盘上下椎体信号异常。38例退变型腰椎间盘突出组有34例椎体骨质增生,32例病变节段椎间盘内出现低信号,12例病变椎间盘上下终板信号异常,12例病变椎间盘上下椎体信号出现异常。采用两组χ2检验,两组比较有统计学意义（P〈0.05）。结论：X线及MRI中T2加权像对区分破碎型腰椎间盘疝出和退变型腰椎间盘突出有一定的价值,从而更好指导腰椎间盘突出症的治疗。     

显微内镜手术治疗极外侧型腰椎间盘突出症

目的介绍显微内镜手术治疗极外侧型腰椎间盘突出症的方法,分析其临床效果。方法16例极外侧型腰椎间盘突出症(椎间孔内型7例,椎间孔外型9例)接受显微内镜手术。5例椎间孔内型采用常规显微内镜椎间盘髓核摘除术入路,切除部分椎板、椎弓峡部和小关节。2例椎间孔内型采用经关节突入路,使用X-tube工作通道,切除大部分关节突。9例椎间孔外型采用横突间入路,工作导管置于横突间,部分切断横突间韧带。所有手术均需找到受压神经根并松解,切除突出椎间盘。结果术后平均随访8·3个月,采用改良MacNab标准评定临床结果,优12例,良3例,可1例。平均住院日13·8d,平均手术时间78min,平均术中出血68ml。结论显微内镜手术治疗极外侧腰椎间盘突出症具有小切口和组织损伤轻的优点,能够充分直接探查松解神经根压迫。     

Lumbar disc herniation in the elderly

Thirty-two patients older than 60 years underwent surgical treatment for lumbar disc herniation over a 10-year period. Other causes of low-back pain and sciatica were investigated, and bony nerve root entrapment syndromes were not included. Sciatica was a predominant symptom and was present in all patients, with 81% showing positive nerve root tension signs. Motor deficit was found in more than half of the cases. A sequestrated disc was present in 50%. The follow-up ranged from 1 to 10 years with an average of 50 months. Eighty-seven percent of the patients had excellent or good results. There were no poor results and no one required reoperation. Lumbar disc herniation in the elderly is not a common problem, but surgery yields a high rate of satisfactory results if a proper investigation and correct diagnosis is obtained.     

Lumbar disc excision in children and adolescents

STUDY DESIGN: The authors examined a case series of patients under the age of 18 years treated for lumbar intervertebral disc herniation. OBJECTIVES: To evaluate postoperative and long-term results of surgery in patients younger than 18 years. SUMMARY OF BACKGROUND DATA: There are only a few series, with controversial results, available on the surgical treatment of disc herniation in growing patients. METHODS: Between 1975 and 1991, a consecutive series of 129 patients 9-18 years of age (average age, 16.2 years) underwent surgery for lumbar intervertebral disc herniation. Low back pain associated with leg pain was the main clinical symptom in 106 subjects (82%), back pain in 17 (13%), and leg pain in 6 (5%). RESULTS: Short-term results were excellent or good for 123 cases (95%), with complete pain relief in 97 (75%) and moderate but incomplete relief in 26 (20%). A total of 98 (76%) long-term responses obtained at a mean follow-up of 12.4 years revealed excellent outcomes in 40% of the cases, good in 47%, and poor in 13%. Ten patients (10%) underwent reintervention after 9 years on average (2 fusions and 8 re-explorations for herniated disc). CONCLUSIONS: Results have confirmed a tendency for outcomes to deteriorate between the short-term and long-term follow-up in young patients treated by discectomy: this tendency and the rate of reintervention (10%) confirmed the need for long-term follow-up of children and adolescents treated for disc herniation.     

腰椎间盘突出合并腰神经根管狭窄症（附50例分析）

本文报告50例腰椎间盘突出合并腰神经根管狭窄症,采用扩大式开窗手术。术后随访1～3年,结果优42例,进步7例,优良率87.5％。坐骨神经牵拉试验后出现持续性疼痛是本症与单纯椎间盘突出症的不同之处,并强调术后的稳定治疗。作者认为,把腰椎间盘突出合并腰神经根管狭窄症作为一个完整的疾病名称提出,对于提高治愈率和远期疗效有较重要的临床价值。     

Central Lumbar Disc Herniation

Summary  A follow-up study which describes the experience of the Department of Neurosurgery in Berne in the treatment of patients with central lumbar disc herniation (CLDH).  Background Data. The anatomical position of lumbar disc herniation, in general, does not seem to affect postoperative outcome. However, according to other studies a subgroup of patients with central lumbar disc herniations appears to have poorer results.  Objectives. The aim of the present study was to assess clinical outcome in a recent cohort of patients, to investigate whether there is a difference in outcome with regard to the surgical approach (unilateral vs bilateral) and to compare the postoperative results between the subcategories of CLDH: central massprolaps (CMP) and central contained disc herniation (CCDH).  Methods. Between 1990 and 1997, 40 out of 3150 patients operated on for lumbar disc herniation were diagnosed with CLDH (1.2%). The patients were operated on through unilateral or bilateral fenestrations with microdiscectomy. Recent follow-up studies were obtained by standardized questionnaires. The retrospective investigation was performed by an unbiased observer.  Results. Long-term follow-up was available for 34 of the 40 patients (85%) at a mean of 3.3 years. Eight patients had an excellent result (24%), 15 patients a good result (44%), 8 patients a fair (24%) and 3 patients had a poor result (9%). Overall, the operation was considered successful in 68% of patients. There was no statistically significant difference in outcome in patients with CMP as compared with those with CCDH (75% versus 64%). There was also no significant difference for better outcome between bilateral as compared with unilateral approaches.  Conclusions. Postoperative outcome of central lumbar disc herniation (CLDH) is poorer as compared with other types of lumbar disc herniation. The reason seems to be the anatomical position of the disc herniation with a peculiar derangement of the disc architecture. The surgical approach itself or the subcategories of CLDH appear to have only minor impact on postoperative outcome. Interlaminar fenestrations, in general, are appropriate for removal of the disc fragments.     

经后路360°融合内固定治疗严重腰痛的腰椎间盘突出症

目的总结经后路360°融合内固定治疗合并严重腰痛的腰椎间盘突出症的临床疗效。方法自2005年7月至2008年12月,采用经后路、自体髂骨360°植骨融合及椎弓根钉棒系统内固定术治疗合并严重腰痛的腰椎间盘突出症71例,男38例,女33例;年龄21～59岁,平均38．5岁。随访时间3～18个月,平均9个月,采用临床疗效评分系统进行综合评定,0～1分为优,2～4分为良,5～6分为可,7～9分为差。结果术后切口无不愈合或延迟愈合,无感染。1例患者失访,临床融合率98．6%;临床疗效：优45例,良23例,可2例,优良率97．1％。术后4例患者有腰部僵硬或不适,有明显下肢痛6例（8．6％）,其中5例患者经非手术治疗,于术后1～8周疼痛逐渐消失,另1例患者下肢痛症状顽固且无缓解趋势,行CT检查证实为邻近节段间盘突出,再次手术行椎板间开窗摘除髓核,术后症状消失。结论经后路360°融合内固定最常见的并发症是术后下肢痛,但由于其具有固定坚强、融合确切、症状缓解好和相对经济等优点,故只要严格掌握适应证和手术方法,将是治疗合并有严重腰痛的腰椎间盘突出症的一种较理想的手术方法。