颈椎CT容积扫描轴位椎间盘重组与结合多模式重组对比观察

目的分析颈椎容积扫描图像探讨合理选择颈椎CT扫描方式减少辐射的可能性。方法回顾性研究该院2014年1月—2018年3月间拟诊颈椎病行颈椎容积扫描患者共390例,单独观察轴位椎间盘重组图像与综合观察多模式重组图像并对比分析。结果综合观察对于椎间盘突出、椎间孔变窄、骨性椎管狭窄、椎小关节异常、钩椎关节增生、颈椎椎体骨赘、椎间隙变窄、颈椎不稳、颈椎曲度异常的检出率为26.5%、34.4%、58.5%、52.1%、37.4%、62.1%、60.0%、39.2%、42.6%,较单独观察22.4%、9.5%、30.5%、38.2%、0.0%、53.8%、8.5%、0.0%、0.0%明显更高(χ2=7.10、70.47、61.68、15.10、179.62、5.38、230.07、190.33、210.88,P=0.01、<0.00、<0.00、0.00、<0.00、0.02、<0.00、<0.00、<0.00)。年龄越大,颈椎异常频次越高;综合观察对于椎体后缘无骨赘无后纵韧带骨化组椎间盘突出的发现率与单独观察差异无统计学意义(P>0.05)。结论颈椎CT容积扫描结合多模式重组的应用效果优于轴位椎间盘重组,但对于不伴有明显椎骨增生和韧带钙化的患者,椎间盘突出诊断价值相仿;为了减少对患者辐射,该文推荐对拟诊颈椎病的40岁以下患者经筛选可以选择椎间盘序列扫描。

颈椎动力位MRI检查在椎间盘突出症的诊断价值研究

目的探讨颈椎动力位MRI检查在椎间盘突出症诊断中的诊断价值。方法临床疑有颈椎椎间盘突出症并行颈椎常规中立位和动力位MRI检查的58例患者,对比分析动力位与中立位椎间盘突出的检出率、临床症状和体征的符合率,并行统计学处理。结果在58例232个椎间盘中,过伸位检出椎间盘突出197个(84.9%)显著高于中立位178个(76.7%)(P<0.05),而过屈位检出156个(67.2%)显著低于中立位(P<0.05)。MRI颈椎椎间盘突出检出与临床症状、体征符合率,过伸位符合率达86.2%(50/58),显著高于中立位70.7%(41/58)(P<0.05),而过屈位符合率为51.7%(30/58),显著低于中立位(P<0.05)。各椎间盘突出的检出率,过伸位均高于中立位,而过屈位均低于中立位;其中C4/5、C5/6椎间盘突出的检出率,过伸位显著高于中立位,过屈位显著低于中立位(P<0.05);C3/4、C6/7椎间盘突出的检出率,过屈、过伸位与中立位比较但均无统计学差异(P>0.05)。结论颈椎动力位MRI在椎间盘突出症的诊断中,过伸位是常规中立位的重要补充,其价值优于过屈位。

可调节斜位手术治疗腰椎间盘突出症的临床分析

目的:探讨可调节斜位手术治疗腰椎间盘突出症的临床效果。方法:收治全麻下行腰椎后路间盘切除术患者60例,随机分为俯卧位与斜位两组,其中俯卧位30例,斜位30例,两组患者都行腰椎后路间盘切除术,俯卧位与斜位两组选择不同的体位。结果:经过观察,俯卧位组患者术中平均出血量及手术时间明显大于斜位组(P<0.05)。两组不良反应情况都比较轻微,对比无明显差异(P>0.05)。结论:采用可调节斜位行后路腰椎间盘切除术相对于俯卧位可以减少术中出血量,缩短手术时间,安全性好。

腰椎后缘软骨结节的MRI研究

目的 分析腰椎后缘软骨结节的MRI表现并总结其病理解剖特征。材料与方法 回顾性分析 16例典型病例的MRI表现 ,对比各种扫描序列在显示病变特征上的差异。采用GEVectraⅡ 0 .5T超导型MR机 ,常规行矢状面扫描 ,病变局部横断面GRET2 WI扫描。 5例用GRE序列加作矢状面局部放大扫描。结果 MRI主要表现为病变椎体后上缘或后下缘终板局限性浅弧形凹陷 ,凹陷区内充满椎间盘组织 ,凹陷终板的后缘均超出相邻椎体后缘连线 ,椎间盘后纤维环明显后凸 ,硬膜囊前缘受压。GRET2 WI对上述征象的显示较其他序列清楚 ,可明确显示凹陷的终板有不规则增厚 ,与CT上软骨结节周围骨质硬化相吻合 ;椎间盘后纤维环呈明显低信号 ,3例可见明显断裂。SET1WI在凹陷的终板下方可见带状高信号影。横断面GRET2 WI所见与CT基本相似。 16例中 4例合并髓核脱出。结论 腰椎后缘软骨结节的MRI表现具有特征性 ,GRET2 WI在显示其特征上优于其他序列 ;“腰椎后缘软骨结节”或“腰椎软骨板破裂症”均未能概括该病的主要特征 ,但目前尚无更恰当的命名。

子宫内膜癌腰椎骨转移误诊为腰椎结核

目的分析腰椎转移瘤的误诊原因,并提出防范对策。方法对我院收治的1例子宫内膜癌腰椎骨转移误诊为腰椎结核伴脓肿形成的临床资料进行回顾性分析。结果本例因腰部疼痛半年,进行性加重、不能平卧1个月就诊于当地医院,以腰椎间盘突出症、腰椎结核伴脓肿形成给予理疗、止痛、抗结核治疗,症状无改善转来我院,结合相关检查初步诊断为腰椎转移瘤伴结核脓肿、腰椎结核伴椎旁脓肿、腰椎转移瘤伴化脓性感染。经手术病理证实为子宫内膜癌腰椎骨转移,术后抗肿瘤治疗,随访1年,症状好转,腰部病灶无复发。结论部分妇科恶性肿瘤的癌细胞可经淋巴途径转移至腰椎腹主动脉旁淋巴结,形成癌肿,破坏骨质,且周围组织坏死液化后形成囊肿,与腰椎结核脓肿较难鉴别,临床工作中要引起重视,防止误漏诊。

Protrusion of Lumbar Intervertebral Disc Treated by Ultra Short Wave and the Point Injection in 40 Cases

Since 1996,the author has treated 40 cases of protrusion of lumbar intervertebral disc with ultra short wave and the point injection,and obtained good therapeutic effects.This is reported as follows.

Electroacupuncture and Waist-building Exercise in Treating Lumbar Disk Herniation

Objective： To observe the clinical efficacy of electroacupuncture and waist-building exercise in treating lumbar disk herniation. Methods： A multi-center, randomized controlled trial was adopted. Three hundred cases of lumbar disk herniations were divided into two groups, an observation group in which 149 cases were treated by electroacupuncture and waist-building exercise, and a control group in which 151 cases were treated by electroacupuncture alone. The clinical efficacy and long-term relapse rate were observed and compared between the two groups. Results： Among 149 cases in the observation group, 80 cases were cured, 57 cases improved, 12 cases failed and 4 cases relapsed; the cure rate was 53.7%, the total effective rate was 91.9% and the relapse rate was 5.0%. Among 151 cases in the control group, 74 cases were cured, 51 cases improved, 26 cases failed and 12 cases relapsed; the cure rate was 49.0%, the total effective rate was 82.8% and the relapse rate was 16.2%. There were significant differences in the cure rate and the total effective rate between the two groups （P〈0.05）. Conclusion： Combined electroacupuncture and waist-building exercise had better effects than electroacupuncture in treating lumbar disk herniation.

Observation on therapeutic effect of acupuncture at abdomen acupoints plus tuina for lumbar intervertebral disc herniation

Objective: To observe the clinical efficacy of acupuncture at abdomen acupoints plus tuina for lumbar intervertebral disc herniation (LIDH). Methods: A total of 70 patients with LIDH were randomized into an observation group and a control group, with 35 cases in each group. The observation group was treated with acupuncture at abdomen acupoints plus tuina, while the control group was treated only with tuina treatment. The clinical efficacy was observed after one course of treatment. Results: The cure rate and the total effective rate of the observation group were 83.3% and 96.7%, respectively. The cure rate and the total effective rate of the control group were 39.4% and 78.8%, respectively. There were significant differences in the cured rate and the total effective rate between the two groups (both P<0.05). There was no significant differenee in Japanese Orthopedic Association (JOA) score between the two groups before treatment (P>0.05). After treatment, the JOA scores of both groups in creased sign ifica ntly, and the in tra-group differe nces were statistically sign ifica nt (both P<0.05);the JOA score of the observation group was significantly higher than that of the control group (P<0.05). Conclusion: Acupuncture at abdomen acupoints plus tuina has a better therapeutic effect than tuina alone in the treatment of LIDH.

Influence of Acupuncture plus LONG＇s Manual Manipulations on Functional Improvement in Lumbar Intervertebral Disc Protrusion

Objective： To observe the effect of acupuncture plus LONG＇s manual manipulations on the functional improvement of the patients with lumbar intervertebral disc protrusion. Methods： 60 cases of the patients were randomly divided into a observation group and a control group, 30 cases in each group. The observation group was treated with acupuncture plus LONG＇s manual manipulations, and the control group was treated with single acupuncture. The functions of the lumber vertebrae were processed in accordance with the assessment system of Japanese Orthopedic Association （JOA）, and the therapeutic effects were assessed by Visual Analog Scale （VAS）. Results： After the treatments, the differences in JOA and improvement indexes were statistically significant （P〈0.05） between the two groups. VAS was decreased much remarkably in the observation group （P〈0.01） than before the treatments and decreased remarkably in the control group （P〈0.05） than before the treatments. There was a remarkable difference in VAS between the two groups after the treatments （P〈0.05）. Conclusion： Acupuncture plus LONG＇s manual manipulations are better than single acupuncture in improving the functions of the patients with lumbar intervertebral disc protrusion.

Comparison of biomechanical effect between oblique Ban-pulling manipulation and lumbar erection-rotation manipulation in sitting position for lumbar intervertebral disc herniation

Objective： To compare the biomechanical effects between oblique Ban-pulling manipulation and lumbar erection-rotation manipulation in sitting position in treating lumbar intervertebral disc herniation （LIDH）. Methods： A three-dimensional finite element model of L3-S1 was developed to carry out a comparative study between oblique Ban-pulling manipulation and lumbar erection and rotation manipulation in sitting position. The disc protrusion was assumed to be on the rear left of L4 disc, and the manipulations were performed on the right side. The loading process was simulated by two steps, in the first step, only the compression loading was imposed, and in the second step, both the compression loading and axial rotation moment were imposed. The displacement and stress distribution in L4 disc were investigated. Results： The values of stress and displacement in the second step were lower than those in the first step in each manipulation. The stress and displacement differences between the two steps were respectively 1.79 times and 3.03 times larger in oblique Ban-pulling manipulation than those in lumbar erection-rotation manipulation in sitting position. Conclusion： Oblique Ban-pulling manipulation may result in a better biomechanical effect than lumbar erection-rotation manipulation in sitting position for LIDH.

Clinical Observation on Treatment of 67 Cases with Lumbar Intervertebral Disc Herniation with Abdomen Acupuncture

Objective： To compare the clinical efficacy of abdomen acupuncture with body acupuncture for treating lumbar intervertebral disc protrusion. Methods： One hundred and thirty three patients were randomly allocated to a treatment group of 67 cases and a control group of 66 cases. The patients in the treatment group received abdomen acupuncture and those in the control group, body acupuncture. The improvements in the symptoms were compared after treatment. Results： The efficacy rate was 95.5% in the treatment group and 86.4% in the control group; there was a statistically significant difference between the two groups （P〈0.05）. The cure rate after one course of treatment was significantly higher in the treatment group than in the control group （P〈0.05）. Conclusion： Abdomen acupuncture has a good effect on lumbar intervertebral disc protrusion with a short course of treatment.

Observation of the Therapeutic Effect of Treating Lumbar Intervertebral Disc Protrusion by Acupuncture Therapy

Objective： To observe the clinical effect of treating lumbar intervertebral disc protrusion by needling the points on both sides of the impaired lumbar vertebrae. Methods： One hundred and eighty cases of lumbar intervertebral disc protrusion were randomly divided into three groups, treatment group, control group of acupuncture and control group of western medicine, with 60 cases in each group. The therapeutic effects were compared after 20-day treatments. Result： The effective rate was 96.7% in the treatment group, 80.0% in the acupuncture group, and 81.7% in the Western medicine group. There was a statistically significant difference between the treatment group and two control groups （P〈0.05）. Conclusion： It is an effective therapy to treat lumbar intervertebral disc protrusion by puncturing the acupuncture points on both sides of the impaired lumbar vertebrae.

Exploration of the Clinical Rule of Acupuncturemoxibustion Treatment for Lumbar Intervertebral Disk Herniation

Objective： To review year 1956-2007 literature on acupuncture and moxibustion and explore the regularity of point selection and methods for acupuncture-moxibustion treatment of lumbar intervertebral disk herniation. Methods： A comprehensive analysis was made by a method of metrological analysis according to the data from ＂China modem acupuncture-moxibustion information databank＂. Results： Points Huantiao （GB 30）, Weizhong （BL 40）, Yanglingquan （GB 34）, and Jiaji （Ex-B 2） were most frequently used. Acupuncture was the most frequently used therapy and electroacupuncture, the next one. Conclusion： Electroacupuncture is a common and effective way to treat lumbar intervertebral disk herniation. Points Huantiao （GB 30）, Weizhong （BL 40）, Yanglingquan （GB 34）, and Jiaji （Ex-B 2） can be used as a basic prescription for acupuncture-moxibustion treatment of lumbar intervertebral disk herniation. Other acupoints are selected according to the syndrome.

Therapeutic observation of tuina manipulation for lumbar intervertebral disc herniation

Objective: To observe the clinical efficacy of balance-impact tuina therapy for lumbar intervertebral disc herniation (LIDH). Methods: A total of 118 eligible LIDH patients were randomized into an observation group and a control group by the random number table method, with 59 cases in each group. The observation group was intervened by balance-impact tuina therapy, while the control group was intervened by conventional tuina therapy, both for consecutive two weeks. The scores of visual analog scale (VAS), Oswestry disability index (ODI)Z quality of life questionnaire-core 30 (QOL-C30) were observed before and after treatment;the relapse rate was estimated at the sixth month and twelfth month following the treatment. The data were statistically an a lyzed. Results: After intervention, the total effective rate was 96.6% in the observation group versus 91.5% in the control group, and the between-group differenee was statistically significant (P<0.05). The VAS and ODI scores declined significantly after treatment in both groups (all Pv0.05), and the observation group was markedly lower than the control group (P<0.05, P<0.01). The QOL-C30 score in creased significantly after treatme nt in both groups (both P<0.05), and the observatio n group was markedly higher than the control group (P<0.05). The relapse rates at the post-treatment sixth month and twelfth month in the observation group were lower than those in the control group (P<0.05, P<0.01). Conclusion: Compared with the conventional tuina therapy, the balance-impact tuina therapy shows advantage in lessening pain, improving the function and enhancing the quality of life in the treatment of LIDH, and it has a lower relapse rate. Thus, this therapy is worth promoting in clinic.