经皮摘除术联合胶原酶溶核术治疗腰间盘突出症

The treatment for lumbar disc herniation by percutaneous diskectomy combined with collagenase chemolysis

目的总结胶原酶髓核溶解术联合经皮髓核摘除术治疗腰椎间盘突出症的操作方法和疗效情况。方法选择132例腰椎间盘突出患者进行治疗,共计132个椎间盘,其中L3～41例,L4～586例,L5～S145例。病变椎间盘中包容型42个,非包容型90个。包容型椎间盘突出在行PLD后,向髓核腔内注入600U(2ml)胶原酶;非包容型突出在行PLD后,有54例用5ml生理盐水溶解1200U胶原酶注入到髓核腔内,36例用10ml生理盐水溶解胶原酶1200U,抽取5ml酶液注入到髓核腔内,注射5ml到病变椎间盘相应的硬膜囊前间隙。术后根据突出部位不同而采取不同的卧位。结果显效94例,占71.2%,其中包容型突出38例,非包容型突出56例;有效33例,占25%,其中包容型突出4例,非包容型29例;无效5例,占3.8%,均为非包容型突出。结论经皮椎间盘摘除术联合胶原酶髓核溶解术进一步扩大了微创治疗腰椎间盘突出症的适应证。

Objective To summarize the therapeutic effect and the procedure of the treatment for lumbar disc protrnsion by percutaneous lumbar diskectomy with collagenase chemolysis. Methods 132 cases with 132 lumbar disc protrusions （L3-4 n= 1, L4-5 n=86, L5-S1 , n=45） were enrolled in the study. There were 42 cases with contained and 90 with ruptured. The contained lumbar disc protrusion was treated with 600U （2ml） collagenase, which was injected into the necleus pulposus cavity after PLD. There were 54 ruptured cases was treated with 1200U collagenase solved by 5ml sodium chloride after PLD, which was injected into the nucleus pulposus cavity; there were 36 cases was treated with 5ml collagenase fluid （600U） which was injected into the nucleus pulposus cavity, and 5ml collagenase fluid （600U） was injected into the epidural space. According to the different state of illness the patient took the different position post operation. Results The curative effect rate was 71.2%（94/132）, among which the contained was 38 cases and the ruptured was 56 cases. The effective rate was 25%（33/132）, among which the contained was 4 cases and the ruptured was 29 cases, The ineffective rate was 3.8% （5/132）, all was the ruptured. Conclusions： The percutaneous diskectomy with collagenase chemolysis expanding the indications of the treatment of lumbar protrusion.