Nd:YAG激光与半导体激光对山羊髓核组织生物热效应的比较

Comparison of the bio-heating effect to nucleus pulposus between Nd:YAG laser and diode laser

目的:比较波长1064nm的Nd:YAG激光和波长980nm的半导体激光对椎间盘髓核组织的生物热效应。方法:选取新鲜山羊完整脊柱80具,将其L6/7节段制作成脊柱功能单位标本80个,分为波长1064nm的Nd:YAG激光椎间盘照射组(A组)和波长980nm的半导体激光椎间盘照射组(B组),每组40个标本,再按激光最终照射能量的不同各分为200J、400J、600J、800J、1000J5个亚组,每个亚组8个标本。观察照射前后标本的质量差和照射过程中椎间盘周边的温度变化情况,操作结束后水平切开椎间盘观察汽化腔形态,测量汽化腔的长、宽轴。结果:两组照射后标本的质量减少量随照射能量的增大而增加;在相同能量下,B组激光照射后标本的质量减少量大于A组,在能量分别为200J、400J时比较P<0.05,能量为600J、800J、1000J时比较P<0.01。照射过程中椎间盘前缘、后缘、椎间孔内侧壁的温度升高值随激光能量的增加而升高,当以同一能量进行照射时,B组激光照射过程中椎间盘周边的温度升高值高于A组激光相同位点处的温度升高值(P<0.01)。A组激光照射后肉眼观察汽化腔大致呈圆形或卵圆形,B组激光照射后的汽化腔形态接近于椭圆形,相同能量照射时B组激光的汽化腔长轴大于A组(P<0.01);能量为200J、400J时A组激光汽化腔的宽轴均大于B组(分别为P<0.05,P<0.01),能量为600～1000J时两者比较均无统计学差异(P>0.05)。结论:波长980nm的半导体激光对山羊椎间盘髓核组织的消融能力优于波长1064nm的Nd:YAG激光,但Nd:YAG激光的安全性相对较高。

Objective：To compare the bio-heating effect to nucleus pulposus between 1064nm wave-length Nd：YAG laser and 980nm wave-length diode laser.Method：80 whole fresh goat spine specimen （GSS） were used,S0 L6/7 discs were assigned as spine unit into followings,Nd：YAG laser （group A） and 980nm wavelength diode laser（group B） with each group 40 specimen,and each group was evenly divided into five subgroups according to the final radiate energy from 200J to 1000J.The decreased quality of nucleus pulposus after radiating and the changes of temperature around disc during radiation were observed.After this ,the discs were sliced horizontally to observe the morphology of the cavity and measure the volumn of cavity by sliding caliper.Result：The ablated quality of GSS was greater at higher radiating energy in both groups.Under the same energy,the ablated quality was greater in group B than in group A which showed statistical significance under 200J,400J group（P〈0.05） and under 600J,800J,1000J group（P〈0.01） respectively.The increase of temperature at anterior,posterior border of discs and the intervertebral foramen were greater at higher energy during radiation.The changes of temperature at the same site during radiation were higher in group B than in group A under the same energy （P〈0.01）.The cavities of group A were approximately toroidor ovale-shape under direct vision,while the cavities of group B shaped as elliptic.The long axis in group B was larger than that in group A when compare was processed at the same energy （P〈0.01）.The wide axis in group A was larger than that in group B when compare was processed sub-group （P〈0.01）,while no statistical significance were tively.Conelusion：980nm wave-length diode laser has 1064nm wave-length Nd：YAG laser,but the latter is less at the 200J sub-group （P〈0.05） and at the 400J noted at the 600J,800J,1000J energy group respecbetter ablation capacity to nucleus pulposus than risky.