经颈椎前外侧入路行胶原酶化学溶解术治疗颈椎间盘突出症的临床研究

目的:探讨经颈椎前外侧入路行颈椎椎间盘突出化学溶解术临床应用的可行性及其临床效果。方法:通过标本和解剖学图谱观察颈椎与周围重要器官的关系设计经颈前外侧入路,紧靠气管旁向内后上方穿刺进入颈椎间盘注药。将50例颈椎间盘突出患者随机分成A、B组。A组36例,采用经颈前外侧入路,在椎间盘内注射胶原酶。B组14例,采用颈椎硬膜外置管法,在硬膜外腔注射胶原酶。比较两组的治疗效果和A组治疗前和治疗后主要症状或体征的阳性例数。结果:A组36例病人中,穿刺针均顺利刺入椎间盘,抵达突出物的根部,注射胶原酶400-600U/ml。在1周内产生了明显的治疗效果,未发生并发症。随访6月以上,优良率A组80.6%,B组50.0%两组比较有显著性差异(P<0.05);有效率A组91.7%,B组71.4%。两组比较有显著性差异(P<0.05)。A组治疗前和治疗后主要症状或体征的阳性例数比较有显著性差异(P<0.05)。结论:经颈椎前外侧入路行颈椎椎间盘突出化学溶解术用于治疗颈椎椎间盘突出症是可行性,临床效果显著。

Objective:To evaluate the anterolateral cervical disc herniation cervical spine Clinical application of chemical dissolution of the feasibility and clinical effects.Methods:Cervical specimens and anatomical mapping and observation of the relationship between the design of the surrounding vital organs through the anterior lateral approach,close to the top of the trachea after the puncture side inward injection into the cervical intervertebral disc.The 50 patients with cervical disc herniation were randomly divided into A,B group.A group of 36 patients with anterior lateral approach by,in the intradiscal injection of collagenase.B of 14 patients with cervical epidural catheter method,the epidural injection of collagenase. Comparing the two groups A group therapy treatment and before and after treatment the main symptoms or signs,the number of positive cases. Results:A group of 36 patients,the puncture needle piercing the disc are smooth and arrived protrusion of the roots of injection of collagenase 400 - 600 U/ml.Within 1 week produced a significant treatment effect,no complication.Followed up for 6 months or more,excellent rate A group 80.6%,B group 50.0% and the two groups had significant difference (P < 0.05);efficient A group 91.7%,B group 71.4%.Comparing the two groups was significant difference (P < 0.05).A group treated before and after treatment the main symptoms or signs,the number of positive cases have more significant difference (P < 0.05).Conclusion:The lateral approach for cervical disc herniation cervical spine surgery for the treatment of chemical dissolution,the feasibility of cervical disc herniation,the clinical effect is remarkable.