腰椎间盘突出症治疗适应症的选择.pptxVIP

腰椎间盘突出症治疗适应症的选择;脊柱稳定;脊柱稳定;;椎间盘的解剖与生理;椎间盘的强度维持 ;腰椎间盘突出病因;腰椎间盘突出分型;腰椎间盘突出分型;腰椎间盘突出分型;腰椎间盘突出分型;椎间盘突出症治疗;;椎间盘突出症治疗;椎间盘突出症治疗;;2）半椎板切除椎管减压+髓核摘除术 适应症：①有严重神经根症状保守治疗无效又无条件 行微创手术且椎管容 积相对不大的膨出型 ②反复发作的单纯破裂型（ 有局部严重疤痕增生） ③伴有中央椎管椎管狭窄的单纯破裂型。 ④游离破裂型。 ;3）全椎板切除椎管减压+髓核摘除术 适应症：腰椎间盘突出症伴有严重骨性椎管狭窄。 以上三类手术方法对脊柱稳定性的影响无明显差异。（戴克戎教授和钟世镇教授分别从临床和基础两 方面进行了论证。）;椎间盘突出症治疗;建 议 ;参考文献;21Marti H.Savitz/Johnc.Chiu/Anthony T.Yeung主编. 唐天驷，刘尚李，郑召民等主译 . 微创脊柱外科技术.郑州. 郑州大学出版社，2002，1,68~71. 22高世明，李旭，郭晓东主编.现代医院诊疗常规.合肥.安徽科学技术出版社,2002，1，554. 23 Greenough CG,Fraser RD,Assessment of outcome in patients with lowbackpain.Spine,1992,17(1):36. 24 Olmart K.Rydevik B.Pathophsiology of sciatica Spine,1991,16:223~224. 25 Rassindren FA Boich-Gallego E,Tanaka,et al.Levels of mRNA,coding for motoncuron growth-promoting factors are increased in denervated muscle. Proc Natl A-cad Sci,VSA.1992,89:7194~7198. 26 Yan Q. snider WD,Pinone JJ. Retrograde transport of nerve growth factor (NGF) in motoneurons of developing rats: assessment of potential neurotrophic effects.Neuron,1988,1:335~343. 27 Distefano PS,Friedman B,Radziejewskic, et al.The neurotrophins BDNF,NT-3,and NGF display distinct patterns of retograde axonal transport in peripheral and ceneral neurons. Neuron,1992,8:983~993. 28 Yoshizawa H, Kobayashi S,Morita T. Chronic nerve root compression.Spine,1995,20:397~410. 29 Silvers HR,Lewis PJ. Clabeaux DE, et al. Lumbar disc excisions in patients under the age of 21 year. Spine,1994,19:2387. 30 Loupasis GA Stamos K,Katonis PG,et al.Seven-to 20-year outcome of lumbar discectomy.Spine,1999,24:2313~2317. 31 Brown T,et al.Some mechanical tests on the lumbosacral spine with particular reference to the interverebral discs.J Bone Joint Surg 1957;39A:1 ;谢 谢