医用臭氧治疗腰椎间盘突出症长期疗效分析

Long-term effect of medical ozone in the treatment of lumbar disc herniation

目的评价经皮椎间盘内臭氧注射治疗腰椎间盘突出症的长期疗效。方法回顾性分析南方医科大学珠江医院影像中心及南方医院介入治疗科自2002年7月至2004年3月应用臭氧治疗的324例腰椎间盘突出症患者的临床资料。所有患者均随访≥3年，比较术前和最后随访时日本骨科学会（JOA）评分及下肢根性痛的视觉模拟评分（VAS）；运用改良的MacNab分级法记录最后随访的临床效果并评价患者年龄、病史长短、突出程度及类型等因素对治疗效果的影响。结果本组患者JOA评分、下肢根性痛VAS术前及术后终末随访时比较差异均有统计学意义（6．3±1．4vs13．1±1．2，P=0．018；7．5±0．8vs2．1±0．3，P=0．039），JOA评分、VAS改善率分别为78．2％和70．4％：改良的MacNab分级法记录到最后随访时疗效优良率为77．5％（251／324），患者年龄、病程及椎间盘突出程度对疗效有明显影响；部分（33．8％）包含型突出患者治疗后近期可有症状“反跳”。结论臭氧治疗腰椎间盘突出症术后3年以上随访结果显示疗效令人满意，患者年龄、病程和椎间盘突出程度能影响患者疗效。

Objective To evaluate the long-term effect ofpercutaneous ozone injection into the intervertebral space for treatment of lumbar disc herniation. Methods A retrospective analysis of the clinical data was performed in 324 patients with lumbar disc herniation admitted in Zhujiang Hospital and Nanfang Hospital, Southern Medical University between April, 2000 and March, 2004. All the patients were treated with percutaneous ozone injection into the intervertebral space and followed up for no less than 3 years. The scores of the Japanese Orthopedics Association （JOA） and sciatica Visual Analog Scales （VAS） before and at the end of the follow-up were recorded and compared. The modified MacNab criteria were adopted for evaluation of the effect of the treatment. The patients＇ age, disease course, severity of disc herniation and type of hemiation were also analyzed in relation to the therapeutic effect. Results Compared with the scores recorded before the operation, the average scores of JOA and VAS increased significantly at the end of the follow-up （6.3±1.4 vs 13.1±1.2 for JOA, P=0.0178; 7.5±0.8 vs 2.1±0.3 for VAS, P=0.039）, with JOA and VAS improvement rates of 78.2% and 70.4%, respectively. According to modified MacNab criteria, good therapeutic effect was achieved in 77.5% （251/234） of the cases, the patients＇ age, the disease course and severity of disc herniation showed significant impact on the therapeutic effect. More than one third of the patients （33.8%） with herniation of inclusion type experienced symptom relapse early after the treatment. Conclusion The 3-year follow-up data show that ozone treatment produces satisfactory long-term effect on lumbar disc herniation. The patient＇s age, disease course and severity of herniation are three important factors that affect the long-term therapeutic effect.