经皮腰椎间盘造影确定微创介入方法治疗腰椎间盘突出症疗效观察  

Treatment of lumbar intervertebral disc herniation by different microinvasive interventional therapy ac- cording to transcutaneous lumbar discography

作　　者：顾晖[1] 周玲君[1] 张小雷[1] 钱自亮[1] 

机构地区：[1]湖南省第二人民医院疼痛专科中华疼痛学会第二临床中心,湖南省长沙市410007

出　　处：《实用疼痛学杂志》2011年第3期167-170,共4页Pain Clinic Journal

摘　　要：目的通过经皮腰椎间盘造影术对腰椎间盘突出症行病变椎间盘分型，以便选择腰椎间盘微创介入治疗方法，并评价不同方法的疗效。方法腰椎间盘突出症患者128例，局麻下后路穿刺椎间盘。C型臂下侧位示针尖位于椎间盘的中心或中后1／3交界处，根据腰椎间盘造影将病变椎间盘分为3型：（1）包容型行低温等离子髓核消融术与三氧溶核术；（2）突出型采用突出物处射频消融术与三氧溶核术；（3）破裂型盘内注射胶原酶600U溶核。每组都经椎间孔注射三氧（30μg／m1）5～10ml。术后随访2年，采用MacNab标准评估。结果本组穿刺成功率为100％。造影术分型结果为：包容型占33．6％（43／128例），突出型39．8％（51／128例），破裂型26．6％（34／128例）。治疗后随访2年，优良率包容型为93．0％（40／43例），突出型为88．2％（45／51例），破裂型为82．4％（28／34例）；总优良率为88．3％（113／128例）。结论经皮腰椎间盘造影术能够显示椎间盘的病理形态，可确定病变椎间盘分型，根据分型选择椎间盘突出症微创介入治疗方法，临床疗效满意。Objective To select the method of microinvasive interventional therapy according to the types of interver, tebral disc heriation, classified by transcutaneous lumbar discography, and to evaluate the therapeutic effect of different methods. Methods One hundred and twenty-eight pa- tients diagnosed as lumbar intervertebral disc heriation （LDH） were punctured the intervertebral discs via posterior route under local anesthesia. The needle tip was displayed in the middle or in the junction of 1/3 middle and rear of the intervertebral disc guided by C-arm X-ray. LDH was classified as 3 types： （1） contained heriation type was treated with low-temperature plasma nucleus ablation and ozone in- jection. （2） protrusion type treated with radiofrequency target thermocoagulation ablation and ozone injection. （3） ruptured heriation type treated with collagenase intra-disc injection 600U. All types were injected ozone（30 t^g/ml）5~10 ml into intervertebral foramina. The therapeutic effect was as- sessed by MacNab method and followed up for 2 years after operation. Results The success rate of intervertebral disc puncture was 100~~. The lumbar discograph showed contained heriation in 43 pa- tlents（33.6 ~）, protrusion in 51 patients （39.8 ~） and ruptured heriation in 34 patients （26.6 %）. The effective rate in difference types was 93.0% （40/43 cases） ,88. 2% （45/51 eases） and 82.4% （28/34 cases） respectively in 2 years follow-up. Total effective rate was 88.3% （113/128 ceses）.

关 键 词：腰椎间盘突出症 椎间盘造影术 病变椎间盘分型 外科手术 微创性介入治疗 

分 类 号：R681.53[医药卫生—骨科学]