椎间盘镜下治疗胶原酶溶解术失败的腰椎间盘突出症

Treatment of lumbar intervertebral disc herniation after collagenase injection failure under diskoscope

目的:探讨椎间盘镜下治疗经胶原酶溶解术治疗失败的椎间盘突出症的疗效,分析椎间盘突出症患者采用胶原蛋白酶溶解髓核疗效不佳,甚至症状加重的原因,进一步规范胶原酶治疗椎间盘突出症的适应证。方法:对52例经胶原蛋白酶溶解法治疗失败的腰椎间盘突出症患者(男36例,女16例;年龄18～72岁,平均45岁)采用后路腰椎间盘镜微创手术开窗摘除髓核、扩大侧隐窝及神经根管,充分减压,并定期随访。结果:52例均获得随访,时间3～6个月,48例腰腿痛合并麻木等症状完全缓解,4例残留肢体轻度麻木症状。按改良的Macnab疗效评定标准:优48例,良4例。结论:适应证选择范围过宽、操作不当、定位不准是胶原酶溶解术失败的主要原因。对溶解术治疗失败的患者应用椎间盘镜微创手术进行治疗,具有对椎旁肌损伤小、手术时间短、术后恢复快、对腰椎稳定性影响小等优点。

Objective：To investigate the curative effect of intervertebral disc herniation（after failed treatment with collagenase） under diskoscope and analyze the cause of failure of collagenase treatment.Methods：Fifty-two patients with lumbar intervertebral disc herniation（after failed treatment with collagenase）,including 36 males and 16 females with the mean age of 45 years（ranging 18-72 years） were treated in our hospital.The patients were treated with excising nucleus pulposus,expandient side-crypt and nerve root canal,sufficient decompression through posterior approach.Results：All patients were followed up for 3-6 months,the radicated pain and numbness fully relieved in 48 cases;remained slightly in 4 cases.According to Macnab standard：48 cases obtained excellent result and 4 good.Conclusion：The main failure reasons of collagenase are unsaitable indication and uncorrected manipulation.Adopting surgical treatment under diskoscope for these patients has the advantage of less trauma to muscle,less operation time,fast recovery after operation and less influence to stability of lumber spine.This method can obtain satisfactory effect.