经皮椎间盘内及椎间孔内臭氧注射治疗腰椎间盘突出症的疗效评价

Clinical Efficacy of Oxygen-ozone Therapy for Lumbar Intervertebral Disc Herniation

【目的】评价经皮椎间盘内及椎间孔内臭氧注射治疗腰椎间盘突出症的中期和远期疗效。【方法】742例腰椎间盘突出症患者在CT引导下用21G酒精针穿刺至病变椎间盘内，并注射浓度为60／μg／mL的臭氧气体10～20mL；然后退针至椎间孔时，向椎间孔、硬膜外腔内注入浓度为30～40／μg／mL的臭氧5～10mL，以及得宝松（7mg）、VitB12（O．5mg）和2％利多卡因（2mL）的混合液5mL。通过患者治疗前、治疗后1个月、3个月、6个月、12个月的视觉模拟疼痛评分（VAS）和改良的Macnab＇s评价以及3个月后CT或MRI复查结果观察其疗效。【结果】治疗后1、6、12个月的显效率分别为19．41％、66．71％、53．37％，有效率分别为52．70％、15．23％、22．10％，无效率分别为27．90％、18．06％、24．53％，总有效率分别为72．10％、81．94％、75．47％。38．73％的患者CT检查显示椎间盘有不同程度的回缩。大多数患者在术后3～6个月左右时取得较好的疗效，6个月以后有6．47％的患者再次出现腰腿疼症状。所有患者均未发现严重并发症。【结论】椎间盘内、外臭氧注射是治疗腰椎间盘突出症的一种有效、安全的微创方法，远期能达到良好的治疗效果。

[Objective]To assess the short-and long-term efficacy of percutaneous intradiscal oxygen-ozone injection for the treatment of lumbar intervertebral disc herniation. [Methods] Seven hundred and forty two patients accepted 21G alcohol needle puncture with CT-guided. All patients were injected with 10～20mL oxygen-ozone gas （60 μg/mL）. Then the needle was withdrawn to intervertebral foramen, and 5～10mL oxygen-ozone （30～40μg/mL） combined with 5ml mixtures including 7mg diprospan, 0. 5rag VitB12 and 2mL lidocaine （2%） were injected into intervertebral foramen and epidural space. Therapeutic outcome was assessed on 1st, 3rd,6th and 12th month after treatment by using a modified Macnab＇s method and visual analogue scale （VAS）. [Results]Follow-up results showed a satisfactory outcome. On lst,6th and 12th month after treatment, the overall effective rate was 72.10%, 81.94% and 75.74%, and the excellent rate was 19,41%, 66. 71% and 53.37 %, and the good rate was 52.70%, 15.23 % and 22.10%, and the fair rate was 27.90%, 18. 06% and 24.53%, respectively. CT showed reduction in the size of the herniated disk in only 38.73% of the followed-up patients. Most of the patients got an excellent effect from 3 to 6 months after treatment. At 6 months, lumbar disc herniation recurred in 6. 47% of the patients. No severe complications were found throughout this study. [Conclusion] Percutaneous intradiscal oxygen-ozone injection is an effective and safe method for the treatment of lumbar intervertebral disc herniation.