术前X片定位和术中CT定位下胶原酶溶核术治疗腰椎间盘突出症的比较

A COMPARISON OF TWO GUIDANCE TECHNIQUES WITH COLLAGENASE FOR TREATMENT OF LUMBAR DISC HERNIATION

目的：比较术前X片定位法和术中CT定位法行小关节内缘进针硬膜外前侧间隙注射胶原酶溶核治疗腰椎间盘突出症的穿刺过程和临床疗效。方法：随机选择诊断明确的腰椎间盘突出症患者106例，年龄20～78岁，男52例，女54例，采用小关节内缘进针硬膜外前侧间隙穿刺法盘外注射胶原酶溶液行溶核术。一组用术前X片定位法，术中无影像学支持穿刺；另一组在CT引导下穿刺。观察穿刺过程和临床疗效，随访7～300天。结果：术中CT定位比术前X片定位穿刺更容易。术中CT定位组30天时的优良率68．97％优于术前X片定位组的38．67％（P〈0．01）。结论：术中CT定位下胶原酶溶核术可靠性要好于单纯术前X片定位，其半年内的疗效也要好于后者。

Objective： To compare two different guidance techniques, X-ray before and CT during the chemonucleolysis for treatment of lumbar disc herniation. Methods： One hundred and six patients （54 female and 52 male ） , groups. One received diagnosed as the lumbar disc herniation by CT or MRI, were devided into two X-ray examination as the guidance before the injection; the other underwent the chemonucleolysis under CT guidance. In these two groups, the outcomes were compared postoperation from 7 to 300 days. Results： It~ harder to reach the proper area in the X-ray guidance group than that in CT-guidance group. Excellent and good rates in the CT-guidance group（68.97% ） were better than the X-ray guidance group（38.67%, P 〈0.01 ） at 30＇h day＂ follow-up. Conclusion： Chemonucleolysis can be succesfully performed with the CT-guidance; the long-term analgesic effects are better than X-ray guidance.