突出物内注射胶原酶治疗巨大型腰椎间盘突出症临床分析  

Therapeutic effect of collagenase injected into protuberance on huge lumbar disc herniation

作　　者：王德强[1] 舒春华[1] 马念[1] 徐昕[1] 高勇[1] 

机构地区：[1]山东省滨州市滨州医学院附属医院疼痛科,256603

出　　处：《实用疼痛学杂志》2008年第2期93-97,共5页Pain Clinic Journal

摘　　要：目的观察在突出物内注射胶原酶治疗巨大型腰椎间盘突出症的效果及安全性。方法18例患者均在CT引导下进行穿刺。若为中央型或后外侧型巨大突出者,经椎后小关节内侧缘穿刺到突出的髓核内。穿刺成功后注射2%利多卡因3 ml为试验量,观察15 min后无腰麻迹象,缓慢注入胶原酶600U+生理盐水0.5 ml;若为椎间孔内或椎间孔外突出者,旁开脊椎正中线经小关节外缘穿刺到突出的髓核内,穿刺成功后,同上述。结果本组效果优8例,良6例,可4例,差0例,优良率为77.8%(14/18例),有效率为100%。其中结果优中有2例患者,术后1个月做CT检查,突出物均明显地缩小70%。结论突出物内注射胶原酶治疗巨大型腰椎间盘突出症,有疗效确切、患者创伤和痛苦小等优点,但有一定的风险,要谨慎小心。Objective To study the therapeutic effect and safety of collagenase injected into protu- berance on huge lumbar disc herniation. Methods Eighteen patients with huge lumbar disc herniation were selected in this study. The operation was carried out under CT guidance. At first, the protuberance puncture was performed through inner margin of facet joint into the protuberance center or rear-lateral lumbar disc herniation;Second, the test of local anesthetic was done at the same time;Third, if no physical sign of spinal anesthesia happened for 15 minutes, the collagenase 600 U and NS 0.5 ml was slowly injected. From the side of vertebral midline, the needle was punctured through external margin of facet joint if the protuberance was in inner or outer intervertebral foramen. Results The excellent and good effective rates were 77.8% （14/18 cases）, and the effective rate was 100%. The following up CT scan （after operation 1 month ） showed the protuberance was decreased 70% in 2 of 8 patients. Conclusion The treatment of huge lumbar disc herniation with collagenase injected into protuberance was an effective and minimally invasive method, but it had risk and must be done carefully.

关 键 词：腰椎间盘突出症 椎间盘化学松解术 胶原酶类 病灶内注射 治疗 临床 研究 

分 类 号：R681.5[医药卫生—骨科学]