等离子消融髓核成形术联合臭氧注射治疗神经根型颈椎病临床观察

Clinical study of plasma nucleoplasty ablation combined with ozone injection in the treatment of cervical spondylotic radiculopathy

目的 探讨等离子消融髓核成形术联合医用臭氧介入治疗神经根型颈椎病的临床疗效.方法 选择2014年4月至2017年3月在武汉大学附属同仁医院疼痛科就诊的神经根型颈椎病患者99例,按随机数字表法分为3组,每组33例,其中A组行椎间盘内医用臭氧注射治疗,B组给予等离子消融髓核成形术治疗,C组行低温等离子消融髓核成形术联合臭氧注射治疗.分别于术前、术后1周和术后1、3、6个月评定两组患者视觉模拟评分(VAS)、日本田中靖久(Yasuhisa Tanaka)症状量表20分法则(简称YT20分法)评分.参照改良MacNab评分法在术后6个月时评定临床疗效.结果 3组患者治疗后VAS评分与治疗前相比均降低,YT20评分与治疗前相比均升高,差异有统计学意义(P<0.05);C组在术后所有评估时间点VAS评分及YT20评分改善程度均较A、B组更为明显,差异有统计学意义(P<0.05);术后6个月时A组优良率为84.8%(28/33例),B组优良率为90.9%(30/33例),C组优良率为96.9%(32/33例),C组优良率明显高于A、B组,差异有统计学意义(P<0.05).结论 等离子消融髓核成形术联合臭氧治疗神经根型颈椎病的疗效优于单纯等离子消融髓核成形术或臭氧椎间盘内注射治疗.

Objective To explore the efficacy of plasma nucleoplasty ablation combined with ozone injection in the treatment of cervical spondylotic radiculopathy.Methods Ninety-nine patients with cervical spondylotic radiculopathy in Tongren Hospital of Wuhan University from April 2014 to March 2017 were randomly divided into 3 groups:group A(injection of ozone therapy),group B(plasma nucleoplasty ablation therapy),group C(combined therapy).The visual analogue scales(VAS)and the Japanese Orthopedic Associations of Yasuhisa Tanaka 20(YT20)score were used to evaluate the therapeutic effects at preoperative and postoperative(1 week,1 month,3 months and 6 months)respectively.Postoperative therapeutic effects at 6 months was evaluated by the modified MacNab score.Results The VAS of the three groups decreased after treatment compared with that before treatment,while the YT20 score increased compared with that before treatment,and the differences were statistically significant(P<0.05).In group C,the VAS decreased more than that in group A and B statistically(P<0.05),and the YT20 was significantly higher than that in group A and B(P<0.05).According to the modified MacNab criteria,the excellent and good rate in group A was 84.8%(28/33 cases),in group B and C was 90.9%(30/33 cases)and 96.9%(32/33 cases)respectively.The excellent and good rate of group C was significantly higher than that of group A and B(P<0.05).Conclusion Clinical effects of plasma nucleoplasty ablation combined with ozone injection are better than injection of ozone therapy and plasma nucleoplasty ablation therapy alone for the treatment of patients with cervical spondylotic radiculopathy.