椎弓根钉棒系统固定加椎板间融合治疗腰椎管狭窄症体会

腰椎管狭窄症是指由腰椎骨性和软组织性因素造成的椎管及神经根管狭窄致马尾神经及脊神经根受压[1]。临床表现为腰腿痛、间歇性跛行、下肢感觉运动功能障碍。针对部分保守治疗无效的患者,自2002～2009年,作者采用椎弓根钉棒系统固定加椎板融合治疗腰椎管狭窄症49例,取得满意的疗效,现总结报告如下：     

全椎板切除加椎弓根螺钉固定治疗腰椎管狭窄症

目的探讨全椎板切除加椎弓根螺钉固定治疗腰椎管狭窄症的疗效。方法对16例腰椎管狭窄症患者，采用全椎板切除加椎弓根螺钉系统固定及横突间植骨融合治疗。内固定种类：Dick钉8例，RF系统5例，Steffee钢板3例。结果平均随访3年6个月，参照Nakai疗效评定标准，优8例，良5例，可2例，差1例。平均症状改善率为93％。结论全椎板切除加椎弓根螺钉固定治疗腰椎管狭窄症，具有充分减压及防治脊柱不稳的效果。     

Click’X椎弓根系统治疗多节段严重腰椎管狭窄症

目的探讨AOSYNTHES产品Click’X椎弓根系统治疗多节段严重腰椎管狭窄症应用技术及意义。方法本组18例，平均年龄68．4岁。所有患者在术前均有间歇性跛行病史。术中行多节段广泛椎板切除减压、椎弓根固定、横突间植骨，平均手术节段2～4个，术后疗效评定采用oswestry评分及影像学观察。结果所有患者术前间歇性跛行症状明显缓解，术后CT显示椎管矢状径、前后径明显扩大，术后12个月随访16例，2例失访。oswestry评分87．5％（14／16）。结论Click’X内固定系统具有结构合理、符合生物力学原理，装置方便、创伤小、临床初步应用疗效满意。     

全椎板切除加椎弓根螺钉固定治疗腰椎管狭窄症

目的探讨全椎板切除加椎弓根螺钉固定治疗腰椎管狭窄症的疗效.方法对16例腰椎管狭窄症患者,采用全椎板切除加椎弓根螺钉系统固定及横突间植骨融合治疗.内固定种类Dick钉8例,RF系统5例,Steffee钢板3例.结果平均随访3年6个月,参照Nakai疗效评定标准,优8例,良5例,可2例,差1例.平均症状改善率为93%.结论全椎板切除加椎弓根螺钉固定治疗腰椎管狭窄症,具有充分减压及防治脊柱不稳的效果.     

64例腰椎间盘突出并腰椎管狭窄症的手术治疗

目的 探索治疗腰椎间盘突出并腰椎管狭窄症的有效方法。方法 手术治疗腰椎间盘突出并腰椎管狭窄症64例。结果 术后获访者56例,平均随访时间3年8个月,优52例,良3例,可1例,治愈率98％,显效率100％。结论 手术治疗腰椎间盘突出并腰椎管狭窄目前是比较理想的方法。     

重新认识老年人腰椎管狭窄症的手术治疗

目的：探讨老年人腰椎管狭窄症的特点,提出一种更好的手术方法。方法：通过对216例老年人腰椎管狭窄症患者的影像学等临床资料及手术进行总结分析。结果;老年人腰椎管狭窄来自多方面：1．椎间盘突出;2．黄韧带肥厚;3．椎板及关节突增生;4．纤维环及椎间盘2钙化。腰椎管狭窄呈节段性,主要在椎间隙对应的平面,狭窄范围多涉及两个以上节段。节段性双侧开潜式扩大和／或黄韧带椎间盘切除和／或侧隐窝扩大术可获得良好的效果,优良率灰96．6％。结论：正确分析腰椎管狭窄的因素,有的放矢地手术解除这些因素,即可获得良好疗效。     

Coflex植入术治疗退行性腰椎管狭窄症41例的临床观察

目的探讨腰椎后路棘突间Coflex植入术治疗退行性腰椎管狭窄症（DLSS）的临床疗效。方法 2012年2月至2013年9月期间收治的74例DLSS患者,按愿意分为对照组33例和治疗组41例,其中对照组接受全椎板减压植骨融合内固定术,治疗组接受Coflex植入术。比较两组手术时间、出血量、并发症;日本整形外科学会（JOA）下腰痛评分、疼痛视觉模拟标尺（VAS）评分、美国脊柱损伤协会（ASIA）神经功能分级;X线片测定植入节段椎间隙前后缘的高度、椎弓根间距及Cobb角。结果治疗组与对照组相比,手术时间缩短[（1.02±0.32）h vs（2.13±0.58）h]、术中出血量减少[（145.5±36.0）mL vs（279.3±56.8）mL]、并发症减少（0 vs 9.1%）（P〈0.05）;两组JOA下腰痛评分均较术前明显增高,VAS评分较术前明显降低（P〈0.05）,治疗组术后VAS评分较对照组更低[（2.3±0.3）vs（2.6±0.6）,P〈0.05];术后两组神经功能均有一定程度恢复,但组间比较差异无统计学意义（P〉0.05）;两组患者手术前后植入节段椎间隙前缘高度、椎弓根间距及Cobb角均无明显变化,椎间隙后缘高度均增大[治疗组术前与术后比较[（7.31±1.36）mm vs（8.98±1.56）mm],对照组术前与术后比较[（7.19±1.08）mm vs（8.61±1.41）mm,P均〈0.05],但组间比较差异无统计学意义。结论腰椎后路棘突间Coflex植入术是一种治疗退行性腰椎管狭窄症安全、有效的手术方法。     

腰椎管狭窄症减压修复手术护理体会

腰椎管狭窄是最常见的腰腿痛性疾病,是因椎管发生骨性或纤维性管腔狭窄,由椎间盘突出,黄韧带增厚,小关节突的骨质增生和炎症水肿形成椎管内径狭窄引起,压迫马尾神经或腰骶神经根而引起腰痛,下肢痛,下肢麻木无力,间歇跛行等症状。严重者可有下肢     

手术治疗腰椎管侧隐窝狭窄31例报道

腰椎退行性改变是引起腰椎管狭窄症较常见的原因,其特点是站立和行走时引起腰痛和下肢痛,腰部过伸时这种症状加重。随着影像学检查手段的发展和社会老龄化,腰椎管狭窄症的发病率呈逐年增高趋势,是中老年人腰腿痛的主要原因之一。经     

中西医结合治疗腰椎管狭窄208例

目的探讨腰椎管狭窄临床治疗的方法。方法230例腰椎管狭窄病人，采用中两医结合治疗，治疗时间10～30天，平均20天，回顾性分析其治疗效果。结果经1～3年随访(平均20个月)，按照中华骨科学会脊柱外科的评定标准优62例(29．8％)，良127例(61％)，差19例(9．2％)，优良率90．8％。结论对于腰椎管狭窄症采用卧床休息，适当运动，合理锻炼，骶管疗法，中药的辨证施治等措施，结果表明，本方法为治疗腰椎管狭窄症的一种好方法。     

腰椎椎管狭窄症的中医药治疗研究

腰椎管狭窄症是指腰椎管内一个或多个平面管腔狭窄,神经压迫、移位引发的一种临床综合征,其病因主要为腰椎管退行性病变导致狭窄,或骨性/纤维性增生引发管腔狭窄,对患者生活质量影响较大。腰椎椎管狭窄症是中老年人常见的腰椎疾病,在我国发病率呈明显上升趋势,且呈年轻化态势。近年来,腰椎椎管狭窄症的中医药治疗方法不断优化改进,形成了多样化的治疗体系,治疗效果较为理想,成为治疗该病的重要途径。为进一步总结该病中医药诊治的研究成果,本文对腰椎椎管狭窄症的中医药诊治进展进行综述。     

Neuropathic Pain Components in Patients with Lumbar Spinal Stenosis

Purpose

To determine the prevalence and characteristics of neuropathic pain (NP) in patients with lumbar spinal stenosis (LSS) according to subgroup analysis of symptoms.

Materials and Methods

We prospectively enrolled subjects with LSS (n=86) who were scheduled to undergo spinal surgery. The patients were divided into two groups according to a chief complaint of radicular pain or neurogenic claudication. We measured patient''s pain score using the visual analog scale (VAS), Oswestry Disability Index (ODI) and Leads Assessment of Neuropathic Symptoms and Signs (LANSS). According to LANSS value, the prevalence of NP component pain in patients with LSS was assessed. Statistical analysis was performed to find the relationship between LANSS scores and the other scores.

Results

From our sample of 86 patients, 31 (36.0%) had a NP component, with 24 (63.4%) in the radicular pain group having NP. However, only seven patients (15.6%) in the neurogenic claudication group had NP. The LANSS pain score was not significantly correlated with VAS scores for back pain, but did correlate with VAS scores for leg pain (R=0.73, p<0.001) and with ODI back pain scores (R=0.54, p<0.01).

Conclusion

One-third of the patients with LSS had a NP component. The presence of radicular pain correlated strongly with NP. The severity of leg pain and ODI score were also closely related to a NP component. This data may prove useful to understanding the pain characteristics of LSS and in better designing clinical trials for NP treatment in patients with LSS.     

Conservative and Surgical Treatment Improves Pain and Ankle-Brachial Index in Patients with Lumbar Spinal Stenosis

Purpose

The pathological mechanism of lumbar spinal stenosis is reduced blood flow in nerve roots and degeneration of nerve roots. Exercise and prostaglandin E1 is used for patients with peripheral arterial disease to increase capillary flow around the main artery and improve symptoms; however, the ankle-brachial index (ABI), an estimation of blood flow in the main artery in the leg, does not change after treatment. Lumbar spinal nerve roots contain somatosensory, somatomotor, and unmyelinated autonomic nerves. Improved blood flow by medication with prostaglandin E1 and decompression surgery in these spinal nerve roots may improve the function of nerve fibers innervating muscle, capillary, and main vessels in the lower leg, resulting in an increased ABI. The purpose of the study was to examine whether these treatments can improve ABI.

Materials and Methods

One hundred and seven patients who received conservative treatment such as exercise and medication (n=56) or surgical treatment (n=51) were included. Low back pain and leg pain scores, walking distance, and ABI were measured before treatment and after 3 months of conservative treatment alone or surgical treatment followed by conservative treatment.

Results

Low back pain, leg pain, and walking distance significantly improved after both treatments (p<0.05). ABI significantly increased in each group (p<0.05).

Conclusion

This is the first investigation of changes in ABI after treatment in patients with lumbar spinal stenosis. Improvement of the spinal nerve roots by medication and decompression surgery may improve the supply of blood flow to the lower leg in patients with lumbar spinal stenosis.     

有限元模拟复杂性腰椎管狭窄症减压手术

本文目的是精确建立复杂性腰椎管狭窄症(LSS)的退变腰椎有限元模型和减压手术模型,与正常模型进行对比与分析。首先,选取复杂性LSS患者采集CT数据,采用专用生物力学软件建立退变腰椎全节段模型,同时构建正常材质模型和减压手术模型,用相同边界条件进行对比分析。结果表明:复杂性LSS腰椎的活动度范围比正常模型要小,而减压模型的活动度变大。在应力方面,退变椎间盘L4-L5和邻近上位椎间盘L3-L4的终板、髓核和维环基质应力分布趋向四周边缘集中,而减压手术模型的应力进一步出现较大增加。仿真显示单纯的减压手术虽然可以减缓神经疼痛,但是很可能进一步造成腰椎稳定性的破坏,加速腰椎退变。     

单纯腰椎间盘突出与腰椎管狭窄症对腰椎曲度的影响

目的探讨单纯腰椎间盘突出与腰椎管狭窄症的影像学测量值间的差异及其相关性。方法对178例单纯腰椎间盘突出和162例腰椎管狭窄症患者经手术治疗后的X线、CT、MRI资料进行回顾性对照分析。测量腰椎曲线指数(LCI)、腰椎前凸度(Cobb角)、椎间盘突出指数(IDH)、硬膜囊横截面积(CSADS)、侧隐窝前后径(A-PDLR)(骨性标志),对所测量的数据进行统计学分析。结果腰椎间盘突出组,X线显示为腰椎生理曲度明显变小或消失,并多伴有侧弯;腰椎管狭窄组,X线显示为腰椎生理曲度明显加大,多不伴有侧弯,二者的差异具有显著性(P<0.01)。腰椎间盘突出程度与腰椎生理曲度呈负相关(r=-0.732,P<0.05);腰椎管狭窄程度与腰椎生理曲度呈正相关(r=0.605,P<0.05)。结论腰椎间盘突出和腰椎管狭窄症的腰椎生理曲线不同,突出和狭窄程度与腰椎生理曲线有相关性。     

Incidence of Nocturnal Leg Cramps in Patients with Lumbar Spinal Stenosis before and after Conservative and Surgical Treatment

Purpose

To examine the effects of conservative and surgical treatments for nocturnal leg cramps in patients with lumbar spinal stenosis (LSS). Nocturnal leg cramps is frequently observed in patients with peripheral neuropathy. However, there have been few reports on the relationship between nocturnal leg cramps and LSS, and it remains unknown whether conservative or surgical intervention has an impact on leg cramps in patients with LSS.

Materials and Methods

The subjects were 130 LSS patients with low back and leg pain. Conservative treatment such as exercise, medication, and epidural block was used in 66 patients and surgical treatment such as decompression or decompression and fusion was performed in 64 patients. Pain scores and frequency of nocturnal leg cramps were evaluated based on self-reported questionnaires completed before and 3 months after treatment.

Results

The severity of low back and leg pain was higher and the incidence of nocturnal leg cramps was significantly higher before treatment in the surgically treated group compared with the conservatively treated group. Pain scores improved in both groups after the intervention. The incidence of nocturnal leg cramps was significantly improved by surgical treatment (p=0.027), but not by conservative treatment (p=0.122).

Conclusion

The findings of this prospective study indicate that the prevalence of nocturnal leg cramps is associated with LSS and severity of symptoms. Pain symptoms were improved by conservative or surgical treatment, but only surgery improved nocturnal leg cramps in patients with LSS. Thus, these results indicate that the prevalence of nocturnal leg cramps is associated with spinal nerve compression by LSS.     

后路椎弓根内固定椎体间融合术治疗腰椎滑脱症

目的:探讨后路椎弓根内固定椎间融合术治疗腰椎滑脱症的方法和疗效.方法:选择症状较为典型的腰椎滑脱症病例118例,采用RF椎弓根内固定及后路椎体间融合技术治疗腰椎滑脱症.结果:本组118例患者全部获得随访,随访时间6～30个月,平均24个月,滑脱复位率89.8%(106/118),椎体间融合率91.5%(108/118),无再滑脱现象.所有患者症状均有所缓解.无严重并发症发生.结论:RF椎弓根内固定椎体间融合术可直接复位滑脱椎体,即刻稳定病变节段,增加椎间孔截面积间接扩大侧隐窝而缓解对神经根的卡压,提高融合率.     

复杂性腰椎管狭窄症减压和椎间融合的有限元分析

精确建立复杂性腰椎管狭窄症LSS的退变腰椎有限元模型,进而分析减压手术结合椎弓根内固定、椎体间盘融合的效果。选取复杂性LSS患者采集CT数据,采用专用生物力学软件建立退变腰椎全节段模型,自适应划分网格并交互生成附属组织结构,同时构建正常腰椎模型和三种手术治疗模型,用相同边界条件进行对比分析。复杂性LSS模型活动度比正常模型减少20%左右;而单纯减压模型出现不稳,活动范围增加近40%;结合椎弓根内固定稳定性部分提高、活动范围只增加25%,而进一步结合椎体间盘融合后腰椎弯曲刚度超过正常模型。在应力方面,单纯减压的应力出现较大增加、达到1.7倍左右,结合椎弓根内固定和椎体间盘融合有比较明显的减压作用。显示单纯的减压手术虽然可以缓减神经疼痛,但可能进一步造成腰椎稳定性的破坏,结合椎弓根内固定不能提供全面的稳定性,进一步结合椎体间盘融合的治疗效果比较稳定。     

Roseomonas Spinal Epidural Abscess Complicating Instrumented Posterior Lumbar Interbody Fusion

The first case of a spinal epidural abscess caused by Roseomonas mucosa following instrumented posterior lumbar fusion is presented. Although rare, because of its highly resistant profile, Roseomonas species should be included in the differential diagnosis of epidural abscesses in both immunocompromised and immunocompetent hosts.     

The Efficacy of Physical Therapy and Physical Therapy Plus Calcitonin in the Treatment of Lumbar Spinal Stenosis

Purpose

The aim of our study was to compare the efficacy of physical therapy alone and in combination with calcitonin in patients with neurogenic claudication (NC).

Materials and Methods

In this single blind, and randomized study, patients with lumbar spinal canal stenosis who were diagnosed by clinical findings and MRI and having NC were included. Patients were observed for 8 weeks and evaluated before and after treatment. Patients were randomized between the salmon calcitonin 200 U/day + physical therapy (n = 23) (Group 1) and paracetamol 1,500 mg/day + physical therapy (n = 22) (Group 2) treatment groups. Both groups received the same physical therapy (interferential current + hot pack + short wave diathermy) and exercise protocol. The association of various clinical and functional parameters was assessed statistically by using paired and unpaired t test, chi square test and McNemar''s test. p < 0.05 indicated statistical significant.

Results

Mean age of the patients in Group 1 was 57.6 ± 11.2 and in Group 2 54.5 ± 10.6 years. Before treatment, there were no significant differences between groups with respect to age, body mass index, spinal axial diameter, Visual Analogue Scale (VAS), spinal mobility, functional status and walking distance (p > 0.05). After 8 weeks of treatment, both groups benefited significantly with respect to VAS, functional status and walking distance (p < 0.001). There was no statistically significant difference between groups (p > 0.05).

Conclusion

In 45 patients with lumbar spinal stenosis who received 8 weeks of treatment, concomitant use of calcitonin with physical therapy and exercise did not have any benefical effect on the patient''s pain, functional status, lumbar mobility and walking distance.