射频靶点微创热凝术治疗腰椎间盘突出症  

Clinical study for the treatment of lumbar intervertebral disc protrusion with targeted minimally invasive radiofrequency thermocoagulation

作　　者：吴成富 余四海 刘建树 李靖 

机构地区：[1]河南省信阳市中心医院疼痛科,河南信阳464000

出　　处：《河南大学学报（医学版）》2009年第4期250-251,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：观察射频热凝术治疗腰椎间盘突出症的疗效。方法：选择180例腰椎间盘突出症患者,随机分成2组,每组90例,在C臂X线引导下,A组患者用22G×10 cm射频套管针经小关节内侧缘行病变间隙椎间盘穿刺,经椎间盘造影确认穿刺针位于椎间盘突出物的中心（靶点）,插入射频电极,连接射频仪,测阻抗150-250Ω之间,分别用高频100Hz0、.5-1 mA低电流,低频3Hz、0.5-2 mA高频电流进行感觉运动测试,行70℃、80℃、90℃射频治疗各30 s,无异常反应再行90℃300 s射频治疗。B组患者在A组的基础上,将射频套管针退出椎间盘外硬膜外前间隙,注射激素复合液（20 g/L利多卡因3 ml,复方倍他米松7 mg,神经妥乐平7.2 u）,观察近远期疗效。结果：A、B2组患者2周优良率分别为62.2%、63.4%（P〉0.05）,3个月优良率为75.6%、88.9%（P〈0.01）,6个月优良率分别为78.9%、96.7%（P〈0.01）。结论：射频靶点热凝术是治疗椎间盘突出症的有效方法,微创、并发症少,联合应用激素复合液,疗效明显提高。Objective： To observe the therapeutic effect of radiofrequency thermocoagulation in lumbar intervertebral disc protrusion. Methods： 180 patients with lumbar intervertebral disc protrusion were randomly divided into two groups （n= 90 each）. Guided by X-ray of C-arm, group A were punctured with 22G× 10cm radiofrequency trochars through the medial border of small joint. After confirming the needle in the center of protrusion （target） by discography, inserted the radiofrequency electrode and connected with radiofrequency apparatus. When impedance between 150Ω -250Ω high-frequency 100Hz,0.5-1 mA low electric current and low frequency 3Hz,0.5-2mA high electric current were applied to detect the sense and motion respectively. Radiofrequency therapy were practiced at 70℃ ,80 Cand 90℃. If no paradoxical reaction, a radiofrequency therapy at 90℃ lasted 300 seconds. Based on group A, hormone mixed liquor including lidocaine 3ml complex, Betamethasone 7mg, Neurotropin 7. 2u was injected after exiting epidural anterior diastema in group B, Results： Superordinary percentage of group A and B were 62.2% and 63.4% in two weeks（P〉0.05）respectively, 75.6% and 88.9% in three weeks（P〈0.01）, 78.9% and 96.7% in 6 weeks（P〈0.01）. Conclusion： Targeted radiofrequency thermocoagulation is an effective method in the therapy of lumbar intervertebral disc protrusion with the characteristic of minimal injury and less complication. If combined with hormone mixed liquor, the effect will be better.

关 键 词：射频 微创热凝术 腰椎间盘突出症 

分 类 号：R681.53[医药卫生—骨科学]