双介入方法治疗腰椎间盘脱垂的临床疗效观察  

Clinical observation of double interventional therapy in treating lumbar intervertebral disc prolapse

作　　者：赵洪增[1] 关文华[2] 程敬亮[1] 杨瑞民[3] 

机构地区：[1]郑州大学第一附属医院放射科．河南郑州450052 [2]河南科技大学第一附属医院放射科 [3]新乡医学院第一附属医院介入中心

出　　处：《实用放射学杂志》2012年第6期916-920,共5页Journal of Practical Radiology

基　　金：河南省教育厅自然科学研究计划项目（2006320044）.

摘　　要：目的探讨钳取式经皮腰椎间盘切除术联合盘外胶原酶化学溶核术的双介入疗法对腰椎间盘脱垂的治疗效果。方法用双介入方法治疗经临床及影像资料确诊的腰椎间盘脱垂患者共116例，其中男68例，女48例。急性发作期患者84例，慢性期患着32例。用双介入治疗方法治疗的患者与早期及同期用相同纳入与排除标准进行钳取式经皮腰椎间盘切除术治疗患者的疗效进行比较；对急性发作期治疗的患者与慢性期患者的疗效进行比较；对不同脱垂程度的椎间盘脱垂患者的疗效进行比较。结果 对患者分别进行6个月的随访，用Macnab标准进行疗效评价，双介入方法治疗的优良牢为72.41％，高于单用经皮腰椎间盘切除术37，65％的优良率（P＝0.001〈0.05）；急性期患者治疗的优良率为78.57％，高于慢性期患者56.25％的优良率（P＝0.016〈0.05）；轻度脱垂治疗的优良率为75％。高于重度脱垂患者54.17％的优良率（P＝0.019〈0.05）。结论双介入方法结合了2种介入治疗方法的特点，可提高椎间盘脱垂介入治疗的有效率。Objective To investigate the clinical efficacy in the treatment of lumbar intervertbral disc prolapse （LIDP）with double interventional therapy（percuataneous lumbar disceetomy with forceps combined with epidural chemonucleolysis）. Methods 116 pa- tients with I.IDP proved by clinical and imaging data were treated by the double interventonal therapy,of which,68 cases were male, 48 were female cases. 84 cases were in acute stage,32 cases were in chronic stage. The excellent and good rate of double intervention- al therapy with single percutaneous lumbar discectomy（PLD）（85 cases） were compared; the efficacy of acute stage and chronic stage of LIDP,the different severity of I.IDP were also compared. Results After consecutive follow up for six months, the excellent and good rate of double interventional therapy by using Macnah critria was 72.41% （84/116）, which was significantly higher than that of PLD（37.65% ,32/85） only （P=0.001〈0.05） ;the excellent and good rate of the patients in acute stage （78.57% ,66/84） was sig- nificantly higher than that of chronic stage （56. 25%,18/32） ;the excellent and good rate of slightly severe （ Ⅰ degree） LIDP group （75%,51/68） was significantly higher than that of more severe （ Ⅱ and Ⅲ degree）LIDP group（54. 17%,26/48）.Conclusion The double interventional therapy is an effctive method in treating LIDP,it can improve tile excellent and good rate in the interventional treatment of LIDP.

关 键 词：腰椎 椎间盘脱垂 椎间盘切除 化学溶核术 

分 类 号：R681.53[医药卫生—骨科学] R815[医药卫生—外科学]