低温等离子消融髓核成形术与保守疗法治疗腰椎间盘突出症的对比研究

Prospective and comparative study of nucleoplasty and conservative treatment for lumbar disc herniation

目的：比较低温等离子消融髓核成形术与保守疗法治疗包容性腰椎间盘突出症的疗效。方法：69例经体格检查、CT和／或MRI检查确诊的包容性腰椎间盘突出症患者随机分为两组，髓核成形术治疗组28例，采用低温等离子消融髓核成形术治疗；保守治疗组41例，采用卧床休息、抗炎、理疗等综合保守疗法。随访1年～2年8个月，平均2．1年，采用Prolo功能评定法和VAS评分评定疗效。结果：髓核成形术治疗组和保守治疗组总体治疗成功率分别为82．1％和85．4％，差异无显著性(P＞0．05)；两组平均住院时间分别为7．6d和16．9d，差异有显著性(P＜0．05)；复发率分别为10．8％和22％，差异有显著性(P＜0．05)。髓核成形术治疗组并发椎间盘炎1例，行腰椎融合术后治愈。结论：髓核成形术和保守疗法治疗包容性腰椎间盘突出症的满意率相近，但髓核成形术治疗组复发率低，住院治疗时间短，是一种安全、有效的治疗包容性腰椎间盘突出症的微创治疗方法。

Objective：To comparate the treatment of lumbar disc herniation with nucleoplasty and conserva tive method.Method：Sixty-nine cases of lumbar disc herniation,which were diagnosed by physical examina tion,CT scanning and/or MR imaging,were divided randomly into two groups.Twenty-eight cases were treated with nucleoplasty,and forty-one cases were treated with conservative method.The patients were followed-up for one year to two years and eight months,with an average of 2.1 years.The clinical outcome of all patients were evaluated by Prolo functional and economic rating and patients visual analogue scales （VAS）.Result：The total successful rate of the nucleoplasty treatment group and that of conservative treatment group were 82.1% and 85.4% respectively,which was not significantly different（P〉0.05）. The mean hospital stay of nucleoplasty treatment group was significantly shorter than that of conservative treatment group（7.6 days and 16.9 days respec tively（P〈0.05）. The recurrence rate of nucleoplasty treatment group was significantly lower than that of conservative treatment group（10.8% and 22% respectively,P〈0.05）.One case of discitis was found in the group of nucleoplasty treatment and cured by lumbar fusion later.Conclusion：The successful rate of nucleoplasty group is similar to that of the conservative treatment group,but the recurrence rate of the group of nucleoplasty is lower,and its mean hospital stay is shorter than that of conservative treatment group.As a new minimally invasive technique,nucleoplasty is an effective,safe treatment for contained lumbar disc herniation.