CT导引经皮穿刺臭氧椎间盘溶解术治疗腰椎间盘突出症

Percutaneous treatment of herniated lumbar disc by intradiscal oxygen-ozone injection under guidence of CT

目的观察CT导引经皮穿刺臭氧椎间盘溶解术治疗腰椎间盘突出症的临床疗效及安全性。方法31例经CT或MRI检查证实为腰椎间盘突出症患者,其中椎间盘膨出5例,突出24例,脱出2例。在CT导引下采用19～21G穿刺针经皮穿刺至椎间盘,实施盘内及椎管内或椎间孔周围臭氧注射术。盘内注射臭氧浓度为50～60μg/ml,注射量5～10ml;椎管内或椎间孔周围注射浓度为30～40μg/ml,注射量10～15ml。随访3～6个月。按Macnab和SF-36生存质量调查问卷(中文版)来评定疗效。结果总有效率为81.7%,优19例(60.4%),良6例(19.3%),差6例(19.3%);治疗后患者在躯体健康(PF)、躯体角色功能(RP)、躯体疼痛(BP)、总体健康(GH)、生命活力(VT)、社会功能(SF)、情绪角色功能(RE)、心理健康(MH)等8个维度上均较治疗前有显著改善(P<0.01),在终得分上也有显著提高(P<0.01)。无一例严重并发症发生。结论CT导引经皮穿刺臭氧椎间盘溶解术治疗腰椎间盘突出症具有创伤小、安全性高、恢复快、疗效确切等优点,是治疗腰椎间盘突出症安全有效的方法。

Objective To evaluate the efficacy and safety of the percutaneous treatment of herniated lumbar disc by intradiscal oxygen-ozone injection under guidence of CT. Methods The technique was used in 31 patients with lumber discs herniation. The diagnosis of lumbar disc herniatation including 5 bulging, 24 portrusion and 2 extrusion was verified by CT or MR imaging. The patients were injected 5-10 ml medical ozone into discs with 19-21G needles under guidence of CT. The ozone concentration was 50-60μg/ml and 10-15 ml of mendical ozone was given for the disc injection, which was 30-40μg/ml for intratheacal or paravertebral space. The follow-up period was 3-6 months. Results According to the Macnab＇s criterin and SF-36,excellent response was achieved in 19 cases, good response in 6 cases, fair/poor in 6 cases. All domains of the quality of life in patients were significantly increased （P 〈 0.01 ）, including PF, RP, BP, GH, VT, SF, RE and MH. No severe complications were found throughout this study. Conclusion Percutaneous intradiscal ozone-injection on lumber discs herniatation under guidence of CT has many advantages of less injury, safety, effect and fast recovery. It provides an effective and safe path to treat lumber discs herniation.