目的 探讨经Kambin三角顶点入路椎间孔镜手术在髓核高度上游离椎间盘突出症中的应用价值.方法 回顾性分析76例髓核高度上游离椎间盘突出症患者的临床资料,其中经Kambin三角顶点入路椎间孔镜手术治疗的38例患者纳入观察组;基线资料与观察组匹配,且经椎板间入路椎间孔镜手术治疗的38例患者作为对照组.比较两组的手术出血量、切口长度、手术时间、术后卧床时间、住院时间,以及手术前后腰痛和下肢疼痛的VAS评分.结果 两组手术出血量、手术时间、术后卧床时间及住院时间比较,差异均无统计学意义(均P＞0.05);观察组的切口长度短于对照组(P＜0.05).术前、术后24 h及术后1年两组腰痛和下肢疼痛的VAS评分差异均无统计学意义(均P＞0.05),但两组术后24 h、术后1年腰痛VAS评分及下肢疼痛的VAS评分均显著低于术前(均P＜0.05).结论 经Kambin三角顶点和经椎板间两种入路的椎间孔镜手术治疗髓核高度上游离椎间盘突出症疗效显著.临床上可结合患者的实际情况选择个性化治疗方案.

目的 分析自发性椎管内硬膜外血肿(SSEH)的影像学特征及临床治疗效果.方法 回顾性分析2008年6月—2018年9月泰州市人民医院脊柱外科收治的SSEH患者临床资料,分析其影像学表现.采用硬膜外脊髓压迫(ESCC)分级评估硬膜外占位对硬膜囊及脊髓的压迫程度,美国脊髓损伤协会(ASIA)分级评估神经功能,疼痛视觉模拟量表(VAS)评分评估疼痛情况.结果 本研究共纳入12例患者,年龄25～74岁,中位年龄64.5岁.MRI显示SSEH大多呈梭形、椭圆形,且多位于脊髓侧后方或后方的硬膜外腔.血肿最多发于颈段(4例)或颈胸段(4例).血肿累及1～4个节段,平均2.6个节段.T1WI MRI上7例表现为等信号,4例表现为高信号,1例表现为低信号;T2WI MRI上10例表现为高/混杂信号,2例表现为低信号.血肿压迫脊髓程度(ESCC分级)与患者神经功能损伤程度(AISA分级)密切相关(r=0.85,P<0.01).7例患者行手术治疗,其中5例术后神经功能有所恢复,2例术前ASIA分级为A级的患者末次随访时仍为A级;5例采用非手术治疗,治疗后神经功能均有所恢复,VAS评分下降.结论 MRI是诊断SSEH的最佳检查方法.根据患者神经功能损伤及进展情形,可选择非手术治疗或尽早手术治疗.

骨嗜酸性肉芽肿是郎格罕氏细胞组织细胞增生症的一种类型[1].骨嗜酸性肉芽肿发病率低,好发于儿童,成人少见,于脊柱发病者更为少见[2].脊柱嗜酸性肉芽肿病变可侵犯单个或多个椎体,以单发多见[3].笔者于2016-12诊治成人颈椎嗜酸性肉芽肿1例,报道如下.

自发性腰椎黄韧带内血肿临床罕见,可造成神经根或硬膜囊受压,引起临床症状.本文报道1例自发性腰椎黄韧带内血肿引起神经根性症状患者的临床资料,采用MRI脊神经根成像技术获得诊断,手术治疗后压迫症状消失.

目的 研究经皮椎间孔镜下腰椎间盘切除术治疗脱出游离型腰椎间盘突出症的临床疗效.方法 选择2016年8月～2017年8月治疗的38例脱出游离型腰椎间盘突出症患者,均采用经皮椎间孔镜下腰椎间盘切除治疗,随访1年,比较治疗前后ODI指数、JOA评分、腰部及下肢VAS评分,术后1年采用改良MacNab标准评价临床疗效,记录随访期间并发症情况.结果 38例患者均成功完成手术,手术时间(92.41±21.01)min,住院时间(5.65±0.45)d;术后5 d、3个月、1年的ODI指数、腰部及下肢疼痛VAS评分均显著低于术前,JOA评分显著高于术前,且术后3个月、1年与术后5 d比较差异有统计学意义(P<0.05),术后3个月与术后1年比较差异无统计学意义(P>0.05);术后1年按MacNab标准评价疗效,手术优良率为89.47％;术后1例患者出现一过性下肢疼痛,无其他严重并发症发生.结论 在把握严格适应证的基础上采用经皮椎间孔镜下腰椎间盘切除术治疗脱出游离型腰椎间盘突出症能获得良好疗效,且操作安全性高.

The goal of this study was to compare the difference of internal pressure in the multifidus muscle under different deep fascia approaches via muscle pressure measurement, so as to provide the basis for clinical selection of deep fascia incision via the Wiltse approach. Twenty patients with lumbar vertebral degeneration were enrolled from September 2009 to January 2013. The patients were treated with different surgical approaches on both sides. One side used the classic Wiltse approach, where the median incision was made and followed by subcutaneous separation to the spinous process, then deep fascia was cut to intermuscular space. The other side used the modified paraspinal muscle approach, where deep fascia was cut along the supraspinous ligament and peeled off under fascia to intermuscular space. Self-designed retractors (2.5 cm-wide) were placed in both groups to measure muscle pressure under the tension of 0 N, 5 N, 10 N, and 15 N. Differences in pressure between patients in the two groups under four states were compared via paired experiment. The pressure on both sides of muscle under tension of 0 N was similar, and there was no difference between the two groups (P=0.139). Under tension of 5 N, 10 N, and 15 N, there were differences between the two groups (P<0.05), and with the increase of tension the pressure difference between the two groups was increased significantly. The incision site of deep fascia is an important factor affecting the pressure of multifidus muscle operation via the Wiltse approach. It is important to choose the appropriate incision mode of deep fascia for reducing the pressure and protecting the multifidus muscle.

Objective To measure the radiological data of the fibular capitellum which can be used for design of a surgical approach and an anatomical plate for the fibular capitellum.Methods Enrolled in the present study were 38 healthy volunteers (60 normal knees),including 22 males (38 knees) and 16 females (22 knees).They were aged from 18 to 60 years (average,44.8 years).They were divided into 2 groups twice according to gender and body height.Group A1 was males while group A2 females; group B1 included subjects of 156 to 170 cm in height while B2 subjects of 171 to 185 cm in height.The 60 knees were subjected to CT scan before three-dimensional (3-D) reconstruction for measurements of the bony region from the articular surface of the capitellum to the articular surface of the lateral tibial plateau.The 3-D CT images of the lateral tibial plateau were divided into 3 categories:division Ⅰ covering the posterolateral condyle of the tibial plateau,division Ⅱ covering the superior region of the capitellum and division Ⅲ covering the anterolateral region of the tibia.At the same time,the 60 knees were examined by MRI scanning to measure the bone-ligament region from the lateral tibial plateau to the lateral collateral ligaments.All the data were analyzed and compared.Results The narrowest width of the bony region was 11.13 ± 1.43 mm; the narrowest width of the bone-ligament region was 5.35 ± 0.78 mm.In division Ⅱ,the narrowest width of the bony region in group A1 (11.45 ± 1.48 mm) was significantly longer than in group A2 (10.58 ± 1.34 mm),but that in group B1 (10.32 ± 1.40 mm) was significantly shorter than in group B2 (11.63 ± 1.45 mm) (P ＜ 0.05).The narrowest width of the bone-ligament region in division Ⅱ was 5.45 ± 0.82 mm in group A1,showing no significant difference from that in group A2 (5.18 ±0.71 mm),B1 (5.11 ±0.74 mm) and B2 (5.50 ±0.80 mm) (P ＞ 0.05).Conclusions The bony space and bone-ligament space in the superior region of the fibular capitellum provide an anatomic basis for design of a superior fibular capitellum approach.The 3-D CT divisions of the lateral tibial plateau and their anatomic measurements are very important for development of an anatomical plate via the superior fibular capitellum approach.