椎間盤手術 - 管道式微創椎間盤切除神經線減壓手術

腰椎椎管/需要用管道式微創椎間盤切除神經線減壓手術的病症

• 單側坐骨神經痛，痛楚於走路時或坐久時增加。
• 磁力共振素描顯示: 
• 腰椎神經線受脫位椎間盤壓迫。 
• 神經線沒有在神經孔外側受壓。
• 相對「透皮水刀手術」和「全內視鏡椎間盤手術」，「管道式微創椎間盤手術」適合較年長有骨刺之患者和脊椎盤突出時間已很久的病人。

椎間盤手術的一般步驟

• 手術會在全身麻醉下進行。 手術時間約1小時內。
• 麻醉後放置電位神經線監察儀器。
• 利用X光導航經正中偏左/右側腰部傷口放置約16mm直徑管道儀器。整個手術將會在這管道內進行。
• 利用顯微鏡及微創儀器，移除壓著神經線的組織，可能包括小量椎板、小量小面關節、黃韌帶和椎間盤脫位的部份。
• 只切除椎間盤脫位的部份，保留腰椎承托力。
• 最後縫合傷口

椎間盤手術後治療

• 坐骨神經痛及背痛會消除或減至輕微的程度。
• 手術後24小時可如常走動。
• 平均住院約兩天。
• 輕微傷口痛會維持數天至數星期。
• 首雙星期用腰封減少傷口痛。
• 由於腰椎活動能力保留，其鄰近關節退化較融合手術低。

椎間盤手術的風險和併發症

• 常見短期的併發症: 傷口痛，傷口腫脹，腳部輕微的痹痛或刺痛。
• 很少出現的併發症: 傷口流血、細菌感染、神經線持續發炎、腦脊液滲漏。如果出現這些情況一般只需要藥物及休養，在某些特殊情況下可能要進行手術治療。
• 未有出現過的潛在嚴重併發症: 腳步無力，大小便失控
• 一般麻醉引發潛在的疾病、如心臟病或過敏反應。
• 手術後有很少的機會，椎間盤脫位復發。復發機會視乎原有椎間盤脫位的嚴重程度。

參考資料 : www.brain-spine.com.hk/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向香港神經外科醫生查詢，而不應單倚賴以上提供的資料。

本腦炎 / 流行性乙型腦炎 Japanese Encephalitis / Epidemic Encephalitis B

日本腦炎病毒的宿主是豬隻或野生雀鳥，而主要病媒是三帶喙庫蚊，庫蚊在叮咬過帶有日本腦炎病毒的豬隻或野鳥後，身上就帶有該些病毒；庫蚊再叮咬人類，人類就可能被感染日本腦炎。

病徵:
日本腦炎發病的潛服期為四至十四天。病情輕微者出現無力、發燒及頭痛症狀。病情嚴重者則病發得快，並出現頭痛、高燒、頸部僵硬、神志不清、昏迷、震顫、抽搐（特別是幼童）及癱瘓等症狀。患者有可能出現腦膜炎等嚴重病癥，

死亡率可高達三成。

成因:
日本腦炎是經由庫蚊傳播，並不會人傳人，因為人類即使染病，體內的日本腦炎病毒也不會像豬隻或野鳥般多，故蚊子叮咬了患者後，再叮人的傳播風險不大。

預防方法 :
預防日本腦炎，應採取防蚊措施，避免給蚊子叮咬。準備前往此病流行地區如越南、柬埔寨、緬甸、印度、尼泊爾及馬來西亞的人士，更應加倍注意。應避免前往郊外，或穿著長袖衣服及準備蚊怕水。

治療方法:
日本腦炎並無特定的治療方法。醫生一般對患者施以支援性治療。

此病的死亡率為百分之五至三十五，康復者可能有神經系統的後遺症。

是否有季節性?  否

藍明權  神經外科醫生

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，

應向神經外科醫生查詢，而不應單倚賴以上提供的資料。

Degenerative Disc Disease (DDD) (4)

PLIF

The PLIF procedure takes a posterior (from the back) approach to the lumbar spine through an incision in the patient’s back. The surgeon must detach and move muscles attached to the vertebral, and in some cases a portion of vertebral bone called the lamina, may be removed for better visualization and access to the disc space.

-Surgical times ranges from 3 to 8 hours

-Hospital stay ranges from 3 to 5 days

-Typically a 6-inch incision

-Dissection of muscle and soft-tissue of the spine can cause post-operative pain and slow healing process

-Risks reported in literature of vascular injury, nerve injury, incontinence, impotence, muscle and tissue scarring

TLIF

Like the PLIF procedure, TLIF begins with a posterior (from the back) incision, however the surgical angle approaches the vertebra more laterally, or diagonally toward the patient’s side. The altered approach to the spine, compared to PLIF, limits some of the operative trauma to supporting muscle and soft tissue.

To access the disc space, the surgeon may remove a portion of the lamina (a bone covering the spinal nerves) and all of the facet joint, which is a major stabilizer of the spine. The access route, though less invasive than the PLIF procedure, still involves disruption of muscle, soft tissue and nerves and it may pose a risk of post-operative pain and complications.

-Surgical times range 2 to 4 hours

-Hospital stay ranges from 3 to 5 days

-Typically a 4-inch incision

-Risks reported in literature of vascular injury, nerve injury, incontinence, impotence, muscle and tissue scarring

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Degenerative Disc Disease (DDD) (3)

Treatments

There are various methods of treating low-back pain including both non-surgical, and surgical techniques. Your doctor will work closely with you to isolate the source of your low-back pain and recommend the course of treatment that is most appropriate for you.

In most cases, a non-surgical treatment will be recommended. Treatments can range from exercise and behavior modification, to medications that reduce pain or swelling, or epidural injections. While some patients may improve with non-surgical treatments, others may try several treatments without success. In such cases, doctors may recommend a surgical treatment.

Fusion techniques

There are several surgical techniques available for spine fusion. Traditional techniques approach the spine directly through open incisions, while newer, minimally invasive techniques approach the spine through small incisions. If you require spine fusion, the fusion techniques selected may depend on the treatment required for your particular case, individual anatomy, or on the preferences of your surgeon.

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Degenerative Disc Disease (DDD) (2)

Spondylolisthesis

Spondylolisthesis occurs when one vertebra slips forward in relation to an adjacent vertebra. The symptoms that accompany spondylolisthesis include pain in the low back, thighs and/or legs, muscle spasms, weakness, and/or tight hamstring muscles.

-Degree of slippage classified in grades, Grade I being the least amount, Grade IV the most

-Many people affected experience no pain or symptoms

-May result from improper lifting of heavy items, weightlifting, or high impact sports, such as football or gymnastics

Common symptoms

-Low back pain

-Lordosis (swayback)

-Pain and/or weakness in legs

-Tightness in the hamstrings (muscles at back of thigh)

-Symptoms grow worse with exercise

Spinal stenosis

Spinal stenosis is the narrowing of the canal that surrounds the spinal cord. The narrowing can be caused by the enlargement of joints, arthritis, bone spurs or the calcification of ligaments in the spine. As the canal narrows, pressure may be placed on nerves causing pain and/or numbness felt in the back and legs.

-A degenerative condition that is most common in older adults

-Years of wear-and-tear contribute to the condition

-It is possible to be born with spinal stenosis

Common symptoms

-Low back pain

-Weakness, tingling, numbness or pain in legs

-Standing or walking brings on symptoms

-Rest may reduce symptoms

-Leaning forward often relieves symptoms

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Degenerative Disc Disease (DDD)

Degenerative disc disease is not truly a disease. It’s a term used to describe the gradual deterioration of intervertebral discs that may occur naturally with the aging process or as result of injury.
-loss of hydration in the disc can shrink the disc and compromise its ability to act as a shock absorber between each vertebra

-loss of disc height can place pressure on the nerve roots causing pain in the buttocks and legs

-ruptured discs can bulge and put pressure on nerves causing leg and back pain




Common symptoms

-Low back pain
-Pain in legs and/or buttocks
-Pain may increase while sitting or standing for extended time
-Pain may decrease while walking, or laying down

Conditions contributing to low back pain

Painful conditions of the spine may be difficult to understand because often the pain is felt elsewhere, such as in your legs or buttocks. This pain is caused by pressure placed upon the nerves that pass through your spine and extend through the rest of your body.


We’ve seen how the healthy spine works to protect its own structure, including the spinal cord and the nerves that pass through it. We’ll now focus on some conditions that can compromise the normal structure of the spine resulting in nerve compression and pain:

-Degenerative Disc Disease
-Spondylolisthesis
-Stenosis








It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Why do I need surgery?(2)

Preparing for surgery

You may be told to see your general practitioner before surgery to check your overall health. Tell your doctor what medications you are taking, and ask if you should stop taking any medications before surgery. To make your recovery easier, prepare your home for life after surgery. Place important things within easy reach. Remove safety hazards that might cause you to lose your balance. Arrange for someone to help you at home and around the house after surgery. You will most likely be told not to eat or drink the night before the surgery. Be sure you read and understand this entire booklet. Your surgeon is required to let you know of the potential risks, as well as benefits, of this surgery.

After surgery

Ask your surgeon about your specific recovery plan following surgery. It is important to follow your doctor’s instructions carefully to recover from surgery as quickly as possible and increase your chances of a successful outcome.

After surgery your surgeon may refer you to physical therapist who will teach you exercises to improve your strength and increase your mobility. The goal of physical therapy is to help you become active as soon as possible, using safe body movements that protect your neck.

Recovering from pain and surgery is an ongoing process. How fast you recover depends on your commitment to working closely with your physical therapist, and moving and exercising correctly, as recommended by your surgeon.

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

Why do I need surgery?(1)

As discs lose their water content because of disease or age, they lose their height and bring the vertebrae closer together. The consequence is a weakening of the shock absorption properties of the disc and a narrowing of the openings for the nerves in the sides of the spine. Additionally, a loss of disc height may cause the formation of bone spurs, which can push against your spinal cord and/or nerves.

When a disc ruptures in the cervical spine, it puts pressure on one or more nerve roots (called nerve root compression) or on the spinal cord, causing pain and other symptoms in the neck and arms. Living with this pain or weakness and tingling in the arms can be disabling.

Disc degeneration

With the advice of your doctor, you may have tried other treatments for some time now which did not relieve your pain or dysfunction. Or perhaps your doctor has determined that irreparable damage would result without surgery. Your doctor has recommended that you consider the PRESTIGE® LP Cervical Disc Prosthesis, which provides for motion following surgery, instead of the more common fusion procedure.

What is involved in a PRESTIGE® LP Cervical Disc System procedure?

This surgery involves the use of a new medical device, which is designed to replace the disc which sits between the vertebrae in your neck. Your disc, which is damaged or diseased, is surgically removed through an incision made in the front of the neck.

In its place, your surgeon will prepare a space and insert a PRESTIGE® LP Cervical Disc Prosthesis. The device utilizes a ball and socket design which is designed to allow for motion to be preserved.

It is not intended as medical advice to any specific person. If you have any need for personal advice or have any questions regarding your health, please consult your orthopedic doctors for diagnosis and treatment.

婦食3大閘蟹 須長服膽固醇藥

大閘蟹季節碰上中秋國慶長假，肥蟹與蟹宴熱銷，但應適可而止。有中年女士一次過吃兩、三只大閘蟹，致膽固醇指數突飈高，結果美味過後要付出代價，需長期服食降膽固醇藥物，也有人貪吃大閘蟹而致中風。

有醫生指，長期進食高膽固醇食品可致慢性血管疾病，秋涼轉季更可增中風風險。


今年豐收 節後價回落1成
今年江蘇太湖和陽澄湖大閘蟹大豐收，「老三陽」董事長祁廣楠指，今年大閘蟹價格，細蟹和大蟹分別最多便宜兩成和一成，五両半至7両的中大蟹，每斤約400元。
臨近中秋，內地因送禮而搶貴價格，但中秋過後價格將回落一成，他預計今年整體銷情將較去年增兩成。

另外，有海鮮酒家已推出大閘蟹宴，每位除了蟹粉菜式，還包食「兩王一後」3只大閘蟹，負責人指近日訂位相當爆滿。

雖然美食當前，卻要小心身體。心髒科專科醫生李麗芬表示，近年一名40多歲女士，本身有家族性膽固醇過高和心髒病問題，她卻忍不住貪吃大閘蟹，還一次過吃了兩至三只大蟹，致膽固醇指數突然飈升。




連吃6天 中年人急性中風
李麗芬指，該女病人本身也有高血壓、膽固醇指數已達6（正常應為5.2），本來不用服藥治療，可靠飲食控制，但吃完蟹後指數急升至7，結果往後都要長期吃降膽固醇的藥物控制。
「除非做到指數降到正常人一樣，但好難，加上她又有家族史，所以多數要長期食藥。」李麗芬說。

另外，有中年人到訪蘇州，連吃6日大閘蟹而出現急性中風，要急送回港求醫。
食過量致慢性血管病

腦神經專科醫生藍明權指，中風個案多發生在天氣轉變時，尤其由熱轉冷為病發高危期，因氣溫轉變致血壓驟升和血管收窄，加上不少人會在這時期進食補品，因多是膽固醇過高的食物，亦易引致慢性中風。

藍明權續表示：「食物很少致急性中風，多是慢慢累積引致。」
根據世衞建議，一般成年人每天攝取膽固醇的上限為300毫克，一只重約6両的大閘蟹，可食用的約100克蟹肉和蟹膏，膽固醇含量達267克，接近每日可攝取上限，故健康人士每次只宜吃一至兩只，而長期病患者包括心髒病患者及患有高膽固醇人士更不宜進食。


心髒病高膽固醇者 忌進食
香港營養學會會長丁浩恩建議，健康人士每天只可吃一至兩只大閘蟹，有血管疾病的長期病患者進食就不要吃膏，但蟹肉也含豐富脂肪和蛋白質，加上節日多聚餐，提醒每餐都不要進食過量，「不要常說只是一餐半餐，一個星期加上來便會好多餐！」







資料來源: http://www.hket.com/

以上所提供的資訊僅作為教育及參考用途，如果你有任何醫療問題，
應向神經外科醫生查詢，而不應單倚賴以上提供的資料。