等离子体髓核成形术的疗效观察

Observation of therapeutic effects of nucleoplasty

目的：探讨髓核成形术治疗腰椎间盘突出症的作用机制并评价其疗效。方法：选择64例单节段腰椎间盘突出症患者，男37例，女27例；年龄26～60岁，平均42．9岁；病程1～30年，平均为4．2年。L4．5突出30例，L5S1突出34例。于髓核成形术前后测定椎间盘内压，观察其变化，同时行椎间盘造影，判断椎间盘突出类型，并于术后6个月评价其疗效。结果：根据造影结果将病变椎间盘分为两型：Ⅰ型为突出型，Ⅱ型为破裂型。在髓核成形术前，Ⅰ型患者椎间盘内压明显高于Ⅱ型患者（P〈0．01）；髓核成形术后，工型患者椎间盘内压较术前明显下降（P〈0．01），Ⅱ型患者椎间盘内压较术前变化不明显（P〉0．05）；工型患者术后疗效优于Ⅱ型患者（P〈0．05）。结论：作为一种新技术，髓核成形术能明显降低Ⅰ型患者椎间盘内压，改善其症状，是一种安全、有效的微创介入手术。

Objective： To explore the mechanism of nucleoplasty for the treatment of lumbar disc herniation, and to evaluate its therapeutic effects. Methods： Among 64 patients with single lumbar disc herniation, 37 were male and 27 were female, ranging in age from 26 to 60 years, with an average of 42.9 years. The course of this disease ranged from 1 to 30 years,meanly 4.2 years. Thirty patients had the herniation at L4.5, and 34 patients at L5S1. Intradiscal pressure was measured before and after nucleoplasty in order to observe its changes. Discography was done to judge the type of disc herniation before nucleoplasty and therapeutic effects were evaluated at 6th month after operation. Results： According to the results of discography, herniated disc were elms,sifted into two types：Type Ⅰ was protrusion and Type Ⅱ was rupture. Before nucleoplasty, the intradiscal pressure in the patients with Type Ⅰ herniation was significantly higher than that of Type Ⅱ （P〈 0.01）. After nucleoplasty, the intradiscal pressure in the patients with Type Ⅰ herniation decreased significantly comparing with that of preoperation （P 〈 0.01）, but the pressure in the patients of Type Ⅱ herniation had no obvious changes （P 〉 0.05）. The therapeutic effect of patients with Type Ⅰ herniation was better than that of Type Ⅱ （P 〈 0.05）. Conclusion： As a new technique, nucleoplasty can decrease the intradiscal pressure, improve the symptom of patients with Type Ⅰ , which is a safe, effective and minimally invasive operation.