冷消融技术在颈椎间盘突出治疗中的应用

Treatment of cervical disc herniation using coblation technology

[目的]回顾分析等离子冷消融技术治疗颈椎间盘突出症的临床疗效.[方法]2003年1月～2006年4月,应用等离子冷消融技术治疗127例（197个间隙）包含型颈椎间盘突出症患者.其中男81例,女46例;平均年龄49岁.其中C3、4间隙17个,C4、5间隙61个,C5、6间隙90个,C6、7间隙为29个.症状以持续性颈部疼痛和上肢根性症状为主,经过3个月以上保守治疗无效.MRI显示有颈椎间盘突出压迫神经根.全部患者术前及术后采用症状缓解率（VAS评分）和病患主观满意度分级进行疗效评估.[结果]124例患者术后症状即刻显著减轻,3例以上肢麻木为主诉者症状无改善.术后1周症状缓解率平均64%,主观满意度优良率达91%,术后平均随访18个月（6～31个月）,末次随访时,平均症状缓解率47%,主观满意度优良率为62%.其中7例获得2年以上长期稳定疗效,15例症状回复接近术前,其余症状均有小部分反复,仍在观察中.本组未出现局部血肿、感染和神经损伤等并发症.[结论]临床结果显示冷消融技术创伤小、安全,对保守治疗无效而又暂无开放手术指征的包含型颈椎间盘突出患者显示出良好的治疗前景,并可作为开放手术的良好补充.

[ Objective] To retrospectively analyze the results of plasma-mediated coblation in treating cervical disc herniation. [Method] From January 2003 to April 2006, 127 symptomatic cases （197 disc levels） with cervical contained disc herniation were treated with plasma-mediated coblation technology, including 81 males and 46 females, their average age was 49 years, the treated disc levels were 17 in C3,4, 61 in C4,5, 90 in C5,6 and 29 in C6,7, respectively. All patients were reported to have persistent cervical or unilateral ann pain for a minimum of three months and failed previous conservative treatment. MRI showed herniated cervical disc causing focal compression of the nerve root. An average percentage of symptom relief （ VAS score） and subjective satisfaction were administered to measure symptoms at all visits. [ Result] In the immediate post-operative period, 124 patients reported significant amelioration of symptoms, 3 patients complained of arm numbness did not change clinical status, one week after operation, percentage of symptom relief was 64%, perfect rate of subjective satisfaction was 91%. Patients were followed up for average 18 months （ range 6 - 31 months） postoperatively. Percentage of symptom relief was 47% , perfect rate of subjective satisfaction was 62%. In the last follow-up, 7 patients were observed a stabilization of clinical status over 2 years and in 15 patients the status was similar to preoperation. The other patients referred some residual symptoms and were still under follow-up. There were no complications observed such as hemorrhages, infections and nerve root injurys due to the procedure. [ Conclusion] Our data indicate coblation procedure appearing to be less injury, safety, is a promising treatment option for patients with contained cervical disc herniation who have failed conservative therapies and are not considered candidates for open surgery, also supplementary therapy perioperatively in patients treated with cervical open surgery.