数字减影血管造影机引导硬膜外腔注射胶原酶治疗腰椎间盘突出症安全性及疗效的探讨  

THE SAFETY AND THERAPEUTIC EFFECT OF TREATING LUMBAR DISC HERNIATION WITH EPIDURAL INJECTION OF COLLAGENASE UNDER HIGH RESOLUTION X RAY FLUOROSCOPIC GUIDANCE

作　　者：张海波[1] 高崇荣[1] 卢振和[1] 黄焕森[1] 郑志远[1] 马卓[1] 唐西林[1] 陈德基[1] 

机构地区：[1]广州医学院第二附属医院

出　　处：《中国疼痛医学杂志》2001年第1期26-29,共4页Chinese Journal of Pain Medicine

摘　　要：目的 :探讨数字减影血管造影机 (DSA机 )引导下硬膜外腔注射胶原酶治疗腰椎间盘突出症的安全性和疗效。方法 :选择L4/L5 或L5/S1 椎间盘突出症患者 50例。在DSA机引导下进行定位穿刺 ,经造影剂伊索显 (isovist)和局麻药证实穿刺针进入L4/L5硬膜外间隙或L5/S1 硬膜外侧隐窝后注药。结果 :DSA机能清晰显示腰椎棘突、横突、椎体、椎板、椎间孔、上下关节突和侧隐窝解剖结构 ,硬膜外腔显影清晰。三周及一年优良率分别为 57%和73% ,有效率为 92 %。结论 :DSA机引导硬膜外腔内注射胶原酶的方法 ,具有定位和注射部位准确可靠 ,无明显并发症的特点 ,提高了溶盘术的安全性 ;Objective: To investigate the safety and effectiveness of treating lumbar disc herniation with epidural injection of collagenase under high resolution X ray fluoroscopic guidance (digital subtraction angiography). Methods: Fifty patients with lumbar disc herniation at L 4～L 5 or L 5～S 1 were selected. Collagenase were injected into epidural space at L 4～L 5 or into epidural recess at L 5～S 1 under fluoroscopic control after the puncture needles were confirmed by radiograpy with Isovest and injection of local anesthetics. Results: There are distinct fluoroscopy display of lumbar vertebral processus spinosus,corpus vertebrae, foramen, processus articularis superior/inferior and recess. Three weeks and one year of post operative pain assessment revealed that 57% and 73% of total patients obtained excellent or good results respectively, the total effective rate was 92%～100%. Conclusion: There was distinct radiographic display of lumbar vertebral feature and structure became accurate under high resolution X ray fluoroscopic display, so that determination of puncture and injection location resolution. There is high safety in epidural discolysis and fairly good therapeutic effect of treatment of lumbar disc herniation with epidural injection of collagenase.

关 键 词：胶原酶 椎间盘化学溶解术 腰椎间盘突出症 硬膜外注射 数字减影血管造影机 

分 类 号：R681.53[医药卫生—骨科学]