小角度弯曲针法介入治疗腰5-骶1椎间盘突出症

Treatment of L_5-S_1 disc herniation by minor-angle and curved-needle puncture means

目的探讨小角度弯曲针穿刺法进行腰5-骶1椎间盘或低位腰4～5椎间盘介入治疗的方法和应用效果。方法对50例明显低于髂嵴的腰4-5或腰5-骶1椎间盘突出症患者采取小角度弯曲针法穿刺椎间盘进行介入治疗。透视下旋转血管机的C型臂，使射线方向与椎间隙平行，将皮肤穿刺点位于距离脊柱中线6～8cm处，常规消毒麻醉；将穿刺针的前端2～3cm向一侧弯曲20°后向椎间盘穿刺，侧位观察接近椎间盘后缘时，将穿刺针弯曲端偏向内侧、上方进入椎间盘后外侧部，然后进行椎间盘内臭氧注射或等离子消融治疗。结果椎间盘穿刺顺利，一次穿刺成功者45例，占90％，穿刺针进入椎间隙后多数与椎间隙平行，利于盘内介入操作（40／50，占80％），仅20％穿刺后针尖位置欠理想，但尚可完成臭氧注射溶核。经穿刺针向盘内注射臭氧分布良好，等离子刀头活动范围适合消融需要，手术后近期有效率96％，无明显穿刺并发症。结论小角度弯曲针法可以避免高位髂嵴对低位椎间盘穿刺的限制，提高穿刺针在椎间盘内的位置精度，有利于顺利施行介入处理，减少穿刺损伤，缩短手术时间。

Objective To explore the methods and the clinic effect of minor-angle and curved-needle means in percutaneous lumber interventional radiology of L5-S1 or lower position L4-5 disc herniation. Methods The 50 patients of L4-5 or L5- S1 lumbar disc herniation was treated with minor-angle and curved-needle puncture means under the guidance of X-ray, interventional therapy after the accurate disc puncture. Results One time success rate of disc intervertebrales puncture was 90%（45 cases）. Ozone in the intervertebral disc distribute well. Without serious complication. Conclusion The minor-angle and curved-needle puncture means is a accurate safe and effective method in 4-5 or L5-S1 disc herniation.