胶原酶溶解术联合硬膜外阻滞治疗腰椎间盘突出症疗效分析

Collagenase chemonucleolysis combined with epidural block in the treatment of lumbar intervertebral disc herniation

目的 探讨胶原酶溶解术联合硬膜外阻滞治疗腰椎间盘突出症的疗效.方法 腰椎间盘突出症患者60例,分为3组,各20例：A组单纯行胶原酶溶解术;B组胶原酶溶解术联合硬膜外阻滞治疗;C组单纯行硬膜外阻滞治疗.治疗前1 d,治疗后3 d,2个月,6个月测定疼痛视觉模拟评分（VAS）、直腿抬高试验（SLRT）与治疗优良率以评估治疗效果.结果 三组患者治疗后3 dVAS值、SLRT值均较治疗前1 d明显改善（P〈0.01或P〈0.05）;A组与B组治疗后2个月、6个月VAS值、SLRT值均较治疗前明显降低和提高（P〈0.01或P〈0.05）,C组无明显变化;B组治疗后2个月、6个月较A组与C组的VAS值明显降低、SLRT值明显提高（P〈0.05）.A组治疗后3d、2个月、6个月时治疗优良率分别为：17/20,16/20,13/20;B组分别为：20/20,18/20,16/20;C组分别为：20/20,9/20,6/20;B组2个月,6个月优良率较A组与C组提高.结论 胶原酶溶解术联合硬膜外阻滞治疗腰椎间盘突出症,近期优良率100%,远期优良率达80%,均较单纯行胶原酶溶解术与单纯硬膜外阻滞的效果好.

Objective To investigate the efficacy of treatment by collagenase chemonucleolysis combined with epidural block in patients with lumbar intervertebral disc herniation. Methods Sixty patients with lumbar intervertebral disc herniation were divided into three groups, 20 cases in each. Group A received collagenase cbemonucleolysis only; Group B epidural block combined with collagenase treatment; Group C epidural block only. Therapeutic parameters including visual analogue scale （VAS）, straight leg raising test （SLRT） and overall rating of the treatment were observed at pretreatment,l,3 days and at 2,6 months after the treatment. Results VAS and SLRT were significantly better at 3 days after treatment in all the three groups when compared with pretreatment baseline. （P〈0.05） ;VAS and SLRT were also significantly better in group A and group B at 2 and 6 months compared to baseline（P〈0.05）but not those in group C. Furthermore, these parameters were significantly better in group B when compared with those in group A and C （P〈0.05） at 2 and 6 months after the treatment. Global evaluation of excellent rate at 3 days, 2 months, 6 months were 17/20, 16/20,13/20 in group A, 20/20, 18/20, 16/20 in group B and 20/20, 9/20, 6/20 in group C successively. Conclusion Collagenase chemonucleolysis combined with epidural block provides better effect than either treatment only for the treatment of lumbar intervertebral disc herniation with excellent results of 100% in short-term result and 80% in 6 months long-term evaluation.