基于纤维环退变及破裂程度介入治疗腰椎间盘突出症  

Interventional treatment of lumbar disc herniation based on degeneration and fibrous ring rupture degree

作　　者：王亚进 彭丽霞 周沛林 杜玉清 WANG Yajin;PENG Lixia;ZHOU Peilin;DU Yuqing(Department of Vascular Disease Center,Shanghai Fourth People’s Hospital Affiliated to Tongji University,Shanghai 200434,China;Department of Interventional Radiology,Shidong Hospital Affiliated to University of Shanghai for Science and Technology,Shanghai 200438,China)

机构地区：[1]同济大学附属上海市第四人民医院血管病中心,上海200434 [2]上海理工大学附属市东医院介入放射科,上海200438

出　　处：《中国介入影像与治疗学》2025年第3期201-204,共4页Chinese Journal of Interventional Imaging and Therapy

摘　　要：目的观察基于纤维环退变及破裂程度介入治疗腰椎间盘突出症(LDH)的价值。方法回顾性纳入198例LDH患者;基于数字减影血管造影(DSA)评估椎间盘纤维环退变和破裂程度,据以选择治疗方式并评估疗效。结果对48例椎间盘纤维环退变、破裂但未致突出者行椎间盘内电热纤维环成形术(IDET),对25例1级退变、2度破裂合并轻度突出者行经皮椎间盘切除(PLD)或经皮激光椎间盘减压术(PLDD)+臭氧消融,对23例2级退变、2度及以上破裂合并轻度突出者行靶点射频+臭氧消融,对100例2级及以上退变、2度及以上破裂合并中度及以上突出且突出椎间盘内见对比剂进入者行胶原酶溶解+PLD,对2例3级退变、3度破裂伴椎间隙明显狭窄者行经皮骨水泥椎间盘成形术(PCD)。治疗后12个月,198例中,疗效为优、良好、可及差者分别为75、101、16及6例,治疗有效率96.97%(192/198)。结论根据纤维环退变及破裂程度选择介入治疗用于LDH的效果较佳。Objective To observe the value of interventional treatment of lumbar disc herniation(LDH)based on degree of degeneration and fibrous ring rupture.Methods Totally 198 patients with LDH were retrospectively enrolled.Based on findings in digital subtraction angiography(DSA),the degree of degeneration and fibrous ring rupture were evaluated and different treatments were performed,and the efficacies were observed.Results Intradiscal electrothermal annuloplasty(IDET)were performed in 48 cases with fibrous ring degeneration and rupture of intervertebral disc but without protrusion,percutaneous lumbar diskectomy(PLD)/percutaneous laser disk decompression(PLDD)+ozone ablation were performed in 25 cases with grade 1 degeneration and grade 2 rupture with mild protrusion,targeted radiofrequency+ozone ablation were done in 23 cases with grade 2 degeneration and grade 2 or above rupture with mild protrusion,collagenase dissolution+PLD were done in 100 cases with grade 2 or above degeneration and grade 2 or above rupture with moderate or above protrusion and contrast agent entered into protruded intervertebral disc,while percutaneous cement discoplasty(PCD)were performed in 2 cases with grade 3 degeneration and grade 3 rupture with intervertebral stenosis.Twelve months after treatment,among 198 cases,excellent,good,acceptable and poor therapeutic effect was observed in 75,101,16 and 6 cases,respectively,with the effective rate of 96.97%(192/198).Conclusion Interventional treatments of LDH based on the degree of degeneration and fibrous ring rupture were valuable.

关 键 词：椎间盘移位 血管造影术 数字减影 放射学 介入性 

分 类 号：R681.5[医药卫生—骨科学] R815[医药卫生—外科学]