经皮髓核钳夹术联合臭氧治疗腰椎间盘突出症的应用研究

Percutaneous lumbar discectomy combined with medical ozone in the treatment of lumbar disc herniation

目的 探讨经皮髓核钳夹术（PLD）联合医用臭氧（O3）注射治疗腰椎间盘突出症后O3在椎间盘内外弥散、突出物回缩情况以及临床效果、不良反应、并发症等.方法 选择通过影像检查（CT或MR）结合临床确诊为腰椎间盘突出症的120例患者,按随机数字表法分为3组（PLD组、O3注射组、PLD＋O3注射组）,每组各40例,分别按方案实施治疗.结果 PLD＋O3注射组腰痛发生率最低,O3在椎间盘内外弥散最好;突出物回缩率3组间无明显差异;PLD＋O3注射组术后立即有效率为86%,PLD组为83%,O3注射组为35%;随访6～18个月,PLD＋O3注射组总有效率为92.5%,PLD组为87.5%,O3注射组为77.5%;3组均未发生并发症.结论 PLD联合O3注射治疗腰椎间盘突出症是一种较好的综合治疗方案,安全、有效,可提高治疗效果,减少不良反应.

Objective To observe the distribution of O2-O3 mixture in the disc and the shrinkage of herniation after the application of percutaneous lumbar discectomy （PLD） combined with medical ozone （O3） in patients with lumbar disc herniation, and analyze the clinical effect of PLD combined with O3 and the complications of lumbar disc hemiation. Methods One hundred and twenty patients with lumbar disc herniation proved by imaging （CT or MRI） and physical examinations were divided randomly into 3 groups （n=40）： PLD-treated group, O3-treated group and PLD combined with O3 treatment group.They were treated as planning and their clinical effects were observed. Results PLD combined with O3 treatment group showed a significantly lower incidence of lumbago and obviously better distribution of O3 in or outside the discs as compared with the other 2 groups. The shrinkage rate of herniation was not statistically different among the 3 groups. The effective rate in the PLD combined with O3 treatment group was 86% （34/40）; that in the PLD-treated group was 83% （33/40）; that in the O3-treated group was 35% （14/40）. After 6-18 months follow-up, the total effective rate was as following： 87.5% （35/40） in the PLD-treated group, 77.5% （31/40） in the O3-treated group and 92.5% （37/40） in the PLD combined with O3 treatment group. No complications were found in all the 3 groups. Conclusion PLD combined with O3 is a safe and effective method in the treatment of lumbar disc herniation with less adverse reaction.