胶原酶溶盘术治疗颈椎间盘突出症的概况

该对胶原酶溶盘术治疗颈椎间盘突出症的概况进行了评述。     

胶原酶溶盘术后残留症状的处理

十余年来，胶原酶溶盘术治疗腰椎间盘突出症作为微创治疗方法之一，取得了良好的效果，且得到医学界同仁们的认可。但是，在多个相关专业领域中，有许多临床医师开展这项技术出现了虎头蛇尾的现象，即没能使该项技术普及应用，甚至对其治疗效果提出质疑。据我们体会，除了正确选择适应证和熟练操作因素     

侧隐窝注射胶原酶溶盘术患者的护理

1997年 1月至 1999年 2月我院收治腰间盘突出症 312例 ,采用侧隐窝注射胶原酶溶盘术治疗 ,效果良好。胶原酶溶解间盘需 42ｈ[1] ,为使胶原酶能很好地固定于椎间盘处 ,充分溶解突出间盘 ,并不引起并发症 ,护理是提高治愈率 ,降低并发症的关键。1　一般资料本组 312例 ,除早期 6例曾在Ｃ型臂下验证外 ,余 30 6例均经小关节内侧缘侧隐窝注射治疗 ,男 186例 ,女 12 6例 ,18～ 74岁 ,平均 36 6 8岁 ,住院时间 6～ 46ｄ ,平均 2 3 34±13 6 9ｄ。出院时优良率为 91 70 % ,随访 1年后优良率为 93 10 %。2　护　理2 1　治疗前护理2 1 1　心理护理…     

对胶原酶溶盘术患者实施健康教育程序后治疗效果的观察

目的 :总结运用系统健康教育程序对胶原酶溶盘术患者的效果。方法 :随机将 12 0例分为实验组和对照组各 6 0例。实验组依据系统健康教育程序 ,通过对患者评估 ,制定教育计划 ,实施教育措施 ,应用观察和讨论及自行设定的量表 ,进行反馈、评价 ,达到教育目的。对照组实施传统的宣教形式。结果 :实验组对疾病的相关知识、遵医行为、康复情况及满意度方面明显优于对照组 ,复发率明显低于对照组。结论 :对患者实施系统的健康教育程序可显著提高胶原酶溶盘术的治疗效果     

预先应用利多卡因,地塞米松预防溶盘术后疼痛的临床研究

为预防胶原酶溶盘术后疼痛加重的不良反应,将３０例腰椎间盘突出症患者随机分为２组,Ｉ组（１７例）为利多卡因组,Ⅱ组（１３例）为利多卡因加地塞米松组。在体外利多卡因、地塞米松对胶原酶活性影响的研究基础上,溶盘术之前预先注射上述两组药物入侧隐窝,观察其对溶盘术后疼痛的预防作用。在保证溶盘术疗效的前提下,Ⅰ、Ⅱ组术后ＶＡＳ均低于术前,差异显著或非常显著。术后第１天的ＶＡＳ,Ⅱ组低于Ⅰ组,差异显著（Ｐ〈０．     

胶原酶溶盘术治疗极外侧型腰椎间盘突出症39例

极外侧型腰椎间盘突出症，是指椎间盘向椎间孔或椎问孔外侧突出或脱出，刺激或压迫腰神经根而产生腰腿痛的一种病变。目前治疗以外科手术为主，而胶原酶溶盘术治疗尚未见报道。本组1997年3月至2003年3月共收治39例极外侧型腰椎间盘突出症患者，均行胶原酶溶盘术治疗，取得良好疗效。现报告如下。     

认知疗法联合放松训练对胶原酶溶盘术患者焦虑的影响

目的 探讨认知疗法联合逐渐性肌肉放松训练(CTPRT)对胶原酶溶盘术患者手术焦虑的影响.方法 将120例行胶原酶溶盘术的患者随机分成实验组和对照组各60例,对照组实施常规护理.实验组在常规护理基础上实施CTPRT,观察2组患者手术前后的焦虑状况、腰腿疼痛程度、心率、血压以及术后睡眠和排尿情况.结果 实验组患者的焦虑程度和术后疼痛程度显著低于对照组(P<0.01);手术前30 min及术后回病房的血压、心率值实验组亦显著低于对照组(P<0.01);术后睡眠和排尿情况实验组优于对照组,P<0.05.结论 认知疗法联合逐渐性肌肉放松训练可有效减轻胶原酶溶盘术患者的焦虑情绪,缓解疼痛,改善睡眠.     

实验性胶原酶盘外溶核的肌电图分析

目的主要观察胶原酶盘外溶核后神经根的变化。方法使用丹麦维迪公司生产的Keupoint肌电图仪对40只家兔胶原酶溶核的实验组坐骨神经传导速度在术前及术后1,7,15,30d的变化分别进行测定。结果在实验组中,注射胶原酶后第1天坐骨神经传导速度明显低于术前,而第7,15,30天其传导速度较术前传导速度明显增快;对照组在注射后1,7,15,30d传导速度均较术前减慢。结论胶原酶治疗椎间盘突出,可使损伤的神经根得到恢复而对神经根无破坏作用。     

Regression of motor symptoms after intervertebral disk displacement-induced spinal nerve root lesion. Clinical study]

Ever since the causal relationship between backache, radicular pain and intravertebral disc herniation was established [25], there have been different opinions about the degree of recovery of motor lesions of the nerve root caused by disc herniation. Of 123 patients with a severe motor deficit of the L5 nerve root, 95 patients were available for a follow up examination 4 to 8 years after the operation. The statistical evaluation showed that the degree of recovery of the root lesion was mainly dependent on the age of the patient and the time interval until operation. Even a prior herniation of the disc without much compression of the nerve root can cause chronic damage to the nerve through traction at the trilamellar nerve root fixation. So even in the case of only a small disc hernia with a corresponding nerve root lesion, we would recommend immediate operative therapy.     

胶原酶溶解术治疗腰椎间盘突出症的临床分析及护理

[目的]分析腰椎间盘突出症行胶原酶溶解术的临床治疗及预后,探讨防治策略及护理对策.[方法]回顾分析103例腰椎间盘突出症病人行胶原酶溶解术的临床资料,总结临床经验.[结果]103例病人术后临床治愈62例,显效39例,无效2例,临床总有效率98%,效果满意.[结论]加强腰椎间盘溶解术术前术后护理,能有效减少并发症的发生,提高手术治疗的治愈率.     

连续硬膜外腔镇痛联合胶原酶溶解术治疗腰椎间盘突出症疗效分析

目的：探讨连续硬膜外腔镇痛联合胶原酶溶解术治疗腰椎间盘突出症的临床疗效。方法：64例腰椎间盘突出症患者,随机分为2组：A组连续硬膜外腔镇痛组（33例）,B组连续硬膜外腔镇痛术后联合盘外胶原酶溶解术（31例）。治疗后1周、6个月、12个月对两组患者疗效进行随访。结果：两组治疗后1周、6个月、12个月VAS值均较治疗前明显降低（P<0.01）,JOA值均较治疗前明显提高（P<0.01）。B组治疗后12个月VAS值、JOA值较A组明显改善（P<0.05）。A组治疗后12个月优良率为81.8％,B组治疗后12个月优良率为93.5％,B组治疗后12个月疗效优于A组。结论：连续硬膜外腔镇痛联合胶原酶溶解术治疗腰椎间盘突出症远期疗效优于连续硬膜外腔镇痛组。     

Clinical and electromyographic evaluation after chemonucleolysis for lumbar disk disease.

Results in 200 patients with lumbar disk disease who had chemonucleolysis were evaluated by two means. First, the surgeon evaluated the patients clinically from 6 to 30 months after chemonucleolysis by rating each case as excellent, good, fair, or unimproved. Results were judged excellent or good in 91% of the 153 "clean" cases (without previous operation) and in 53% of the 36 with previous operation; 11 patients were lost to follow-up. No patients were clinically worse than before treatment. Scond, a physiatrist did a repeat electromyogram three months or longer after chemonucleolysis. He judged a patient improved if there was a decrease or disappearance of the positive waves and/or fibrillation potentials noted on initial electromyogram. Based on these objective findings, 90.5% of "clean" cases and 85.4% overall showed improvement. Surgeons' clinical evaluations and the independent physiatrical evaluations based on objective electromyographic findings thus correlated closely.     

周围神经损伤后近侧端Schwann细胞变化的初步研究

目的观察大鼠坐骨神经损伤后近端Schwann细胞（SCs）早期免疫组织化学的变化。方法切断成年Wister大鼠右侧坐骨神经（实验组），切除远侧端及其分支，以近侧端为研究对象，术后1、2、3、4、5、6、7、14天取近侧端（离断平面以近）5mm，进行S-100蛋白和胶质原纤维酸性蛋白（glial fibrillary acidic protein，GFAP）免疫组织化学染色。左侧坐骨神经保持其完整性作为对照组。结果切断坐骨神经后，近侧端GFAP表达逐渐增强，S-100蛋白表达逐渐减弱。结论周围神经损伤后，近侧端SCs存在袁型的变化，非成鞘SCs增多，表明不同类型的轴突信号诱导分化产生的不同类型的SCs，在一定条件下能相互转化，这些改变为周围神经再生提供了细胞学基础。     

Functional capacity after peripheral nerve lesion: significance of pain syndromes

INTRODUCTION: The loss of functional capacity by peripheral nerve lesion is easy to be estimated: A certain neurologic dysfunction results in a characteristic reduction of the former individual capacity. In contrast, the effect of accompanying pain to every-day life and working ability is not known exactly. In this study, we compared the results of judgement in nerve lesions under the circumstances of additional pain syndromes. METHODS: From January 1994 until December 1998 we saw 57 patients with peripheral nerve lesions, part of them with an additional pain syndrome. Beside conventional neurological examination a detailed pain analysis has been done. RESULTS: Lesions of the median or ulnar nerves showed regularly disturbances in neurological functions (10/14 for the median nerve, 13/16 for the ulnar nerve). Astonishing is the fact, that serious pain after nerve lesion only occurs in cases of partial nerve lesion. We saw neuralgias in 6 patients with ulnar neuropathy, in three cases of median nerve lesions we could see severe neuralgia (causalgia we found in 3 cases of ulnar neuropathy, in 6 cases after Median Nerve lesion). Patients with a lesion of the central plexus brachialis showed in 10 of 11 cases an additional pain syndrome. Other nerves have been affected more rarely. For the judgement of the loss of earning capacity we saw an additional pain related diminuition of at least 10% compared to those patients without pain problems. CONCLUSIONS: The common grading scales for peripheral nerve lesions are not suitable in cases accompanied by an additional pain syndrome. Beside a functional deficit the effect of severe pain in these patients has to be estimated. On an average, patients with additional pain-problems get a 10% extended loss of earning capacity, even more in particular cases.     

经皮微波消融良性肝局灶性病变的初步研究

目的 探讨运用经皮微波热消融治疗良性肝局灶性病变的原则和价值.方法 应用15G水冷式微波电极经皮消融14例15个良性肝局灶性病变,直径(26.2±13.6)mm(10～57 mm).结果 微波消融治疗次数为(1.4±0.5)次(1～2次),总治疗时间为(837±574)s(300～2057 s).随访1～35个月,中位随访期6个月.治疗后1个月增强影像检查显示,病灶均被微波消融所致凝固性坏死区完全覆盖.随访3个月以上者12例,随访影像检奁显示消融区范围逐渐缩小.围手术期和随访中无一例出现并发症.消融治疗副作用主要有局部疼痛不适(12/14例)、发热(8/14例)、肝酶学指标升高(14/14例)等,前两者持续时间1～9 d,肝酶学指标升高于治疗后1周左右恢复至治疗前水平.结论 经皮微波热消融具有安全、微创、消融彻底、毒副作用低等特点,在把握好适应证的前提下,可作为良性肝局灶性病变的一种可选择的治疗方法.     

骶神经根磁刺激对脊髓损伤后逼尿肌反射亢进的作用

目的：观察骶神经根磁刺激治疗对脊髓损伤所致逼尿肌反射亢进的治疗作用。方法：采用骶神经根磁刺激治疗脊髓损伤后逼尿肌反射亢进的患者,共治疗10天,应用排尿日记、生存质量评分和尿流动力学检查评价疗效。结果：治疗后24h平均排尿次数减少,平均单次排尿量明显增加,平均尿失禁次数相应减少,生存质量提高,治疗有效率达71.4%;尿流动力学结果提示,刺激后最大膀胱测压容积显著增加,充盈末逼尿肌压力明显降低,最大尿流率明显增加。结论：骶神经根磁刺激通过抑制逼尿肌反射,增加膀胱测压容积,增加尿流率,从而改善尿频症状,减少尿失禁,提高生存质量。