胶原酶靶点内外联合注射溶盘术治疗腰椎间盘突出症  

Clinical study on therapy of intervertebral disc protrusion by in tradiscolysis through recessus lateralis with sprotte needle

作　　者：吴成富 刘丽 王文 余四海 李靖 罗华 

机构地区：[1]河南省信阳市中心医院疼痛科,河南信阳464000 [2]北京市中关村医院脊柱微创治疗中心,北京100030

出　　处：《河南大学学报（医学版）》2009年第4期248-249,共2页Journal of Henan University:Medical Science

基　　金：河南省科技攻关项目(0324410089)

摘　　要：目的:比较单纯盘外注射胶原酶和盘内外联合注射胶原酶治疗腰间盘突出症的疗效。方法:选择240例腰间盘突出症患者随机分成2组,每组120例,在C臂X线引导下,A组患者经小关节内侧缘行侧隐窝穿刺,盘外注射胶原酶,B组患者在A组的基础上,自硬膜外针套入腰穿针行盘内穿刺,经椎间盘造影证实位置准确后,盘内注射胶原酶,实现盘内外联合注射,观察近、远期疗效,CT复查结果。结果A、B组2周疼痛缓解率分别为是33.3%、73.3%(P<0.01),3个月优良率分别为80.8%、91.7%(P<0.05),6个月优良率分别为86.7%、97.5%(P<0.01),6个月后CT复查,A组突出椎间盘体积变化不明显,仅密度降低,B组椎间盘突出物消失5例,突出物缩小(≥2 mm)11例。结论:盘内外联合注射胶原酶治疗腰椎间盘突出症临床效果明显高于单纯盘外注射胶原酶。CT复查突出物消失或明显缩小,穿刺径路一次完成,创伤小,安全有效。Objective： To compare therapeutic efficacy of simple extra-disc and intra-combined extra-disc collagenase in-jectionfor lumbar intervertebral disc protrusion. Methods： 240 patients suffering from lumbar interverfebral disc protrusion were divided into two groups randomly（n= 120 for each）, Guided by X-ray, lateral recessus puncture was carried out through inside edge of joint and injected collagenase in group A, In group B after lateral recessus puncture, intra-disc puncture were taken by a lumbar Sprotte-G24 needle. When discography showed the needle was placed in the disc properly, injected collagenase again. Short-term and long-term effects were observed. Results： Percentage of pain remission in Group A and group B were 33.3% and 73.3%. respectively2weeks later （p〈 0.05）;80.8%and91.7%3 months later（P〈0.05）.86.7%and 97.5% 6 months later（P〈0.01）.CT examination showed protrusions of group A didn＇t change apparently, only density decreased 6 months later protrusion disappeared in 5 cases, and shrank in 11 cases in group B. Conclusion： The clinical effect of intracombined extradisc collagenase injection is better than that of simple extra-disc collagenase injection. CT examination showed protrusion disappeared or shrank obviously and puncture was carried out just one time, trauma is tiny, safe and effective.

关 键 词：胶原酶 穿刺术 腰间盘突出症 

分 类 号：R681.53[医药卫生—骨科学]