经皮CT椎间盘造影术确定髓核化学溶解方法

THE METHOD OF CHEMONUCLEOLYSIS WAS SELECTED BY THE DISCOGRAPHY WITH CT

目的:通过经皮CT椎间盘造影术对腰椎间盘突出症行病变椎间盘分型,以便确定椎间盘化学髓核溶解方法。方法:本组诊断为腰椎间盘突出症患者118例,局麻下行后外侧径路穿刺入椎间盘。CT断层示针尖位于椎间盘的中心或中后1/3交界处,根据CT椎间盘造影术将病变椎间盘分为三型:(1)包容型;(2)突出型;(3)破裂型。根据病变椎间盘分型选择溶核方法。(1)包容型:盘内外臭氧溶核疗法;(2)突出型:应用臭氧溶核疗法联合胶原酶盘外注射;(3)破裂型:盘内外联合注射胶原酶溶核疗法。每组都经椎间孔注射得宝松1mg。术后随访三年,采用McNab标准评估。结果:本组在CT监测下穿刺成功率为100%。CT腰椎间盘造影术分型结果为:包容型占36.44%(43例),突出型34.75%(41例)和破裂型28.81%(34例)。治疗后随访三年,总有效率分别为:包容型93%,突出型86.8%和破裂型79.1%。结论:(1)经皮CT椎间盘造影术能够显示椎间盘的病理形态改变,可确定椎间盘突出症病变椎间盘分型。(2)通过这种分型选择椎间盘突出症髓核化学溶解术方法,临床远期随访获得满意疗效,且避免了包容型和突出型腰椎间盘突出症胶原酶盘内注射后的疼痛反应,临床推广应用有重要意义。

Abstract Objective：To design the method of chemonucleolysis by the types of intervertebral disc heriation, which was classified by the discography under CT （CTD）. Methods： The 118 patients who were diagnosed as the lumber disc heriation （LDH） were classified as the 3 types： contained heria- tion, protrusion and ruptured heriation by CTD. The method of chemonucleolysis was selected depending on the 3 types ： （ 1 ） contained heriation ： ozone intradisc injectiong; （2） extrusion ： ozone intradisc and collagenase extradisc injection; （3） ruptured heriation： eollagenase intradise and extradise injection. Followed up for 3 years after operation, and the therapeutic efficacy was assessed by the McNab standard. Results： CTD results show contained heriation in 43 patients （36.44%）, protrusion in 41 patients （34. 75% ）, and ruptured heriation in 34 patients （28.81%）. The effective rate in different types was 93% （ n = 43 ）, 86.8% （ n = 41 ） and 79.1% （ n = 34） by 3 year follow-up, individually. Conclusion ： LDH type can be confirmed by CTD, which is important for selection of optimal method of chemonucleolysis, and avoids the adverse effect. The clinical efficacy is very satisfactory after long term follow-up. So, this practice can be widely used in clinics.