经皮低温等离子消融髓核成形术治疗椎间盘源性下腰痛

Percataneous low - temperature plasma ablation nucleoplasty in the treatment of discogenic low back pain

目的回顾性分析经皮低温等离子消融髓核成形术治疗椎间盘源性下腰痛的临床疗效。方法41例复发性下腰痛患者，经X光片、CT和／或MRI检查，结合椎间盘穿刺造影术确诊为椎间盘源性下腰痛。部位：L3/4例，L4/524例，L5／S110例，L4。＋L5／S13例。采用经皮低温等离子消融髓核成形术进行治疗，于术毕即刻、术后3d、术后随访3个月和术后1年采用疼痛视觉评分（visual analogue scales，VAS）和Oswestry功能障碍指数（oswestry disability index，ODI）评分标准进行评定。术后1年疗效按Macnab标准评定。结果本组患者手术时间5～30min，平均15min。出血量1～2ml，平均1．5ml。住院时间3～6d，平均4d。随访时间12—15个月，平均13．2个月，其间2例下腰痛复发，1例为术后3周，另1例在术后4个月。术前、后VAS和ODI评分比较差别具有统计学意义（P〈0．05），而术后各个时间点间比较差异无统计学意义（P〉0．05）。术后1年随访按Macnab分级标准评定，优20例（48．8％），良17例（41．5％），可2例（4．9％），差2例（4.9％），有效率为95．1％。结论经皮低温等离子消融髓核成形术具有操作简单、安全、微创、疗效佳、恢复快等特点，治疗椎间盘源性下腰痛的近中期疗效稳定，是目前治疗椎间盘源性下腰痛的有效方法。

Objective To examine the clinical efficacy of low - temperature plasma ablation nucleoplasty in the treatment of discogenic low back pain. Methods Forty - one patients who suffered from low back pain for at least 3 months were diagnosed as having discogenic low back pain by using X - ray, CT, MRI and pain blocking test after disc puncture. The location of the pain was as follows：L3/4 in 4 cases,L4/5 in 24 cases,LS/S1 in 10 cases and IA/5 ＋ LS/S1 in 3 cases. Before and after the treatment,the low lumbar pain and functions were evaluated by using the visual analogue scales（VAS） and the Oswestry disability index（ODI）. The efficacy was evaluated by using Macnab＇s criteria 1 year after the operation. Results The operative time was 5 -30 min （average： 15 rain）, the blood loss 1 -2 ml （average： 1.5 ml） , and the length of hospital stay 3 -6 d（ average ：4 d）. All the patients were followed up for 12 - 15 months （average 13.2 months）. There were statistically significant differences in VOS between before and after the operation （ P 〈 0.05 ） but no differences were found when comparison of VOS among the different time points during the followup was made（ P 〉 0.05 ）. The similar statistical results were obtained in terms of ODI. One year after the surgery, according to the Macnab＇s criteria, the clinical efficacy was excellent in 20 cases（48.8% ） ,good in 17 cases（4l. 5% ） ,fair in 2 cases（41.5% ） and poor in 3 cases（4.9% ）. The ef- fective rate was 95.1%. Conclusion Percutaneous low - temperature plasma ablation nucleoplasty is effective in the treatment of discogenic low back pain with the advantages of easy manipulation, safety, minimal invasion and quick recovery.