射频消融术联合小剂量胶原酶化学溶解术治疗神经根型颈椎病的疗效评价  

EVALUATION OF TREATMENT FOR CERVICAL SPONDYLOTIC RADICULOPATHY WITH RADIOFREQUENCY ABLATION AND CHEMONUCLEOLYSIS USING LOW-DOSE COLLAGENASE

作　　者：幸泽艇 王梅 张春元[1] 章勇[2] 张学学[2] 张达颖[2] XING Ze-Ting;WANG Mei;ZHANG Chun-Yuan;ZHANG Yong;ZHANG Xue-Xue;ZHANG Da-Ying(Department of Anesthesia and Pain,Fraternity hospital of Zhongshan in Guangdong Province,Zhongshan 528403,China;Department of Anesthesia and Pain,the first affiliated hospital of Nan Chang university,Nanchang 330006,China)

机构地区：[1]中山市博爱医院麻醉疼痛科,中山528403 [2]南昌大学第一附属医院疼痛科,南昌330006

出　　处：《中国疼痛医学杂志》2019年第10期758-764,共7页Chinese Journal of Pain Medicine

基　　金：国家重点临床专科建设项目

摘　　要：目的:观察射频消融术联合小剂量胶原酶化学溶解术(collagenase chemonucleolysis, CC,下文简称RC)治疗神经根型颈椎病(cervical spondylotic radiculopathy, CSR)的效果及安全性。方法:纳入CSR病人25例行RC(RC组)、30例行胶原酶化学溶解术(M组),采用视觉模拟评分法(visual analogue scale, VAS)和MRI测量的椎间孔孔径(intervertebral foramen diameter, IFD)、椎间盘高度(intervertebral disc height, IDH)、突出物的长度(protrusions length, PL)、宽度(width, PW)、面积(protrusion area, PA)以及Odom标准作为评价指标,比较两组术前、术后的情况。结果:与VAS1比较,两组VAS2~VAS5均显著降低(P<0.001);与IDH1、PL1、PW1、S1比较,两组IDH2、PL2、PW2、PA2均显著降低(P<0.001);与术前IFD1比较,两组IFD2显著增大(P <0.001);与M组比较,RC组VAS更小、IDH下降更少,术后优良率更高(均P <0.05)。结论:该手术治疗CSR是安全有效的,集消融和溶解的优点,明显缓解疼痛,减压效果好,保留责任椎间盘高度。Objective: To investigate the safety and efcacy on the treatment to cervical spondylotic radiculopathy(CSR) which was minimally invasively operated by the combination of radiofrequency ablation and chemonucleolysis with low-dose collagenase. Methods: According to the inclusion and exclusion criteria, 25 patients with CSR were included to be operated with the combination operation(RC group) and 30 operated with collagenase chemonucleolysis(M group). The visual analogue scale(VAS) was surveyed and some parameters were measured by the MRI PACS system tools, namely intervertebral foramen diameter(IFD), intervertebral disc height(IDH), protrusions length(PL), width(PW) and protrusion area(PA). The safety and effect of the combination operation were investigated by MRI and Odom standard. Results: Comparing to the VAS1, the VAS2-VAS5 after operation were signicantly decreased(P < 0.001). Comparing with the IDH1, PL1, PW1 and PA1 before operation, the IDH2, PL2, PW2 and PA2 were signicantly decreased(P < 0.001);IFD2 was signicantly increased than IFD1(P < 0.001). Comparing to M group, VAS of RC group was signicantly decreased, IDH of RC group was decreased less(P < 0.05), the excellent and good rate of RC was higher(P < 0.05). Conclusion: The combination minimal invasive operation to treat CSR was safe and effective. It could reduce the symptoms of patient and pressure in the responsible disc, and could also make some big protrusions disappeared satisfactorily with its advantages, meanwhile they could reserve anatomy function of responsible disc mostly.

关 键 词：射频消融术 化学溶解术 神经根型颈椎病 胶原酶 

分 类 号：R68[医药卫生—骨科学]