体感诱发电位监测不同介入方法治疗腰椎间盘突出症近远期疗效比较

Comparison of different interventions for lumbar discherniation:the short-and long-term outcomes monitored by dermatomal somatosensory evoked potential

目的:采用体感诱发电位监测和量化评估激光椎间盘减压术与传统的胶原酶溶核术治疗腰椎间盘突出症的疗效,并做1个月和1年的近远期差异分析。方法:2000-10/2003-04暨南大学医学院第二临床学院脊柱外科收治的符合微创介入治疗适应证的腰椎间盘突出症患者93例,经患者同意,采用随机数字表法分为激光椎间盘减压术组47例和胶原酶溶核术组46例。激光椎间盘减压术组采用激光椎间盘减压术介入治疗,Nd:YAG连续型激光,波长1064nm;胶原酶溶核术组采用胶原酶溶核术治疗,将胶原蛋白溶解酶1200U溶于5mL生理盐水中,缓慢注入。两组患者在治疗前检查记录症状、体征和进行皮节体感诱发电位检查数据,在治疗后1周、1个月、6个月、1年对患者进行随访,复查患者症状、体征和皮节体感诱发电位结果。根据患者症状、体征恢复程度、影像学检查结果和诱发电位表现形式作为评估标准,以优良率作为疗效指标,选择术后1个月和1年为早期和远期疗效评定时间点。结果:术后1个月时,激光椎间盘减压术组47例中有1例失访,胶原酶溶核术组46例中有2例失访,90例患者进入结果分析,至1年随访时,仍为90例。①术后1个月时两组的优良率评分基本一致[(71%(33/46)和66%(29/44),(χ2=0.357,P=0.550)],术后1年时激光椎间盘减压术组治疗优良率显著高于胶原酶溶核术组[85%(39/46),(66%,29/44),(χ2=4.337,P=0.037)]。②术后1个月随访,两组体感诱发电位潜伏期和波幅变化相似,术后1年时,激光椎间盘减压术者的潜伏期缩短和波幅升高与胶原酶溶核术组比较均有显著差异。结论:激光椎间盘减压术与胶原酶溶核术两种方法均能不同程度提高腰椎间盘突出症患者的疗效,近期疗效两种方法相似,术后1年远期随访时激光椎间盘减压治疗技术效果较好。

AIM:To compare the outcomes of lumbar disc herniation(LDH) treated by chemonu cleolysis(CNL) and percutaneous laser disc decompression(PLDD) using dermatomal somatosensory evoked potential(DSEP) and quantitative assessment,and analyze the difference in the outcomes of 1- month and 1- year follow- up between the tw o interventions. METHODS:Between October 2001 and April 2003,93 LDH patients suitable to emplo y microtrauma interventional procedure were selected from the Department of Spin e Surgery,Second Clinical Hospital of Medical College of Jinan University.Based on the patients' consent,they were divided into PLDD group(n=47) and CNL group(n =46) by means of random number table.The patients in PLDD group were treated by PLDD using Nd:YAG successive laser with 1 064- nm wave length,and those in CNL group were treated with CNL by slowly injecting 1 200 U collagenase dissolved in 5 mL normal saline.Symptom and physical signs of each patient were examined and recorded,and the data were measured with DSEP before poperation,1 week,1 month, 6 months and 1 year after operation.The recovery degree of symptom and physical sign,imaging results and phenotypes of evoked potential were used as evaluation criteria,and success rate as effect index to evaluate the short- term and long - term outcomes at postoperative 1 month and 1 year respectively. RESULTS:All the patients were followed up for 1 year except 3 patients(2 in C NL group and 1 in PLDD group).① There were no significant differences in the su ccess rate between CNL and PLDD group at postoperative 1 month[(71% (33/46) vs 66% (29/44)]( χ 2=0.357,P=0.550).But at postoperative 1 year,the success rate was significantly higher in the PLDD group (85% ,39/46)than in the CNL group(6 6% ,29/44)( χ 2=4.337,P=0.037).② The latency and wave amplitude of DSEP wer e similar in the PLDD and CNL groups at 1 month after operation,but at postopera tive 1 year,the latency was shortened and wave amplitude became higher in the PL DD group as compared with the CNL group. CONCLUSION:Both CNL and PLDD are safe and effective for herniated lumbar disc s.The short- term effects of PLDD are similar to those of CNL,but the long- te rm(1 year)effects of PLDD are better than those of CNL.