骨科
词汇介绍
拓展阅读
解析
Discectomy 英 [dɪ'sektəmɪ] 美 [dɪ'sektəmɪ]
释义 n. 椎间盘切除术;椎间盘切除
例句 The mean duration of follow-up after the second discectomy was 52.6 months.二次椎间盘切除术后的随访平均持续时间是52.6个月。
概述
概述与定义
长期以来,椎间盘切除术作为腰椎间盘突出症的常规治疗方法,一直在临床上普遍应用,近期效果良好。近年来,随着手术技术的发展和创新,有许多新型的腰椎内固定器械和融合器应用于临床。
术式的病理解剖基础
将狗的自体髓核匀浆通过导管注入腰硬膜外腔,可引起附近组织明显的炎症反应,包括硬膜及硬膜外脂肪的水肿,纤维蛋白沉积,明显的多形核细胞浸润和少量的组织细胞-淋巴细胞-浆细胞浸润等,由此得出,自体髓核物质对硬膜囊和神经根有化学性致炎作用,当致炎物质释放刺激神经根,但无椎间盘压迫神经根时,就会出现影像学检查和手术探查阴性,但有神经根放射痛的情况。
手术适应症
各种手术方法的指征如下:(1)开窗法:腰痛伴单侧下肢痛,累及一个间隙者。(2)半椎板切除:腰痛伴单侧肢体疼痛,累及两个间隙者;或原诊断为某一间隙突出,术中发现该间隙的病理变化不足以解释术前症状而探查邻近间隙者。(3)全椎板切除:巨大的中央型腰椎间盘突出伴急性马尾神经损伤症状者;髓核摘除术后症状复发,经保守治疗无效需二次手术者。
治疗方法选择原则
针对椎间盘突出不同的病理改变采取恰当的手术方法是获得较好疗效的关键。开窗法适合一侧症状、单间隙的椎间盘突出;半椎板切除适用于一侧症状、相邻双间隙的椎间盘突出;对一侧症状而影像学提示对侧突出明显时,在有症状侧行开窗手术治疗;对双侧症状的椎间盘突出,可根据影像学改变采取主要突出侧开窗或双侧开窗髓核摘除手术;除巨大的中央型硬膜囊内椎间盘突出外,应尽量避免全椎板切除手术。
颈外矫形器对颈前路椎间盘切除融合术患者临床和影像学结果的影响
发表时间:2019-10-05
影响指数:1.8
作者: A. Scerrati
期刊:Acta Neurochirurgica
First described by Robertson and Cloward in the 1950s, ACDF has been widely used to treat cervical myelopathy and radiculopathy. In experienced hands, ACDF represents a relatively straightforward operation with high rate of clinical success. Following ACDF, cervical collars have been used with the aim of preventing further spinal cord injuries promoting vertebral ossification and relieving pain and finally providing patients with an increased sense of security. Despite these theoretical advantages, the routine use of postoperative ECO is still based on a common practice and surgeon’s preference than solid evidence-based literature. Moreover, their use is not without complications, including skin breakdown and damage, difficulty in swallowing, coughing, breathing, and vomiting.
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