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腰椎间盘突出症患者经皮激光汽化减压联合靶点注射胶原酶的效果

Efficacy of percutaneous laser disc decompression combined with injection of collagenase through a target location for treatment of lumbar intervertebral disc protrusion
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摘要 目的 探讨经皮激光汽化减压联合靶点注射胶原酶治疗腰椎间盘突出症的效果。方法拟行椎间盘松解术的腰椎间盘突出症患者90例,年龄31~52岁,体重58~70k,随机分为3组:经皮激光汽化减压组(P组,n=29)、靶点注射胶原酶组(c组,n=31例)和两种方法联合治疗组(PC组,n=30)。P组光纤经穿刺针达病变椎间盘后进行激光汽化减压;C组在CT扫描下调整针尖位置,固定于突出物表面后注入胶原酶400~600U,继续进针刺人突出物后注入200—300U;PC组在激光汽化减压完成后行靶点注射胶原酶溶解术。于术前、术后7、30、60、90d采用改良日本骨科学会下腰痛分级(M-JOA)评价疗效。结果与术前比较,P组和PC组术后各时点M—JOA分级升高,c组术后30、60和90d升高(P〈0.05),术后7d差异无统计学意义(P〉0.05);与术后7d比较,P组术后30dM—JOA分级降低(P〈0.05),术后60、90d差异无统计学意义(P〉0.05),c组和Pc组术后30、60和90dM—JOA分级明显升高(P〈0.05);与Pc组比较,P组和c组术后各时点M—JOA分级明显降低,近期疗效分级降低。结论经皮激光汽化减压联合靶点注射胶原酶治疗腰椎间盘突出症疗效稳定,优于两者单独应用。 Objective To investigate the efficacy of percutaneous laser disc decompression (PLDD) combined with injection of collagenase through a target location for treatment of lumbar intervertebral disc protrusion. Methods Ninety patients with lumbar intervertebral disc protrusion scheduled for discolysis, aged 31-52 yr, weighing 58-70 kg, were randomly divided into 3 groups: PLDD group (group P, n = 29), collagenase injection group (group C, n = 31), PLDD combined with injection of collagenase through a target location group (group PC, n = 30). The puncture was performed under the guidance of CT. Group P was treated using PLDD. Group C was treated with collageuase injection. Group PC was treated with injection of collageuase after PLDD was completed. The therapeutic effect was assessed before operation and on day 7, 30, 60 and 90 after operation using M-JOA score. Results M-JOA grade was significantly higher at the each time point after operation in group P and PC, and on day 30, 60 and 90 after operation in group C than that before operation ( P 〈 0.05). M-JOA grade was significantly lower on day 30 after operation in group P, while higher on day 30, 60 and 90 after operation in group C and PC than that on day 7 after operation (P 〈 0.05). M-JOA grade was significantly lower at the each time point after operation in group P and C than in group PC. Conclusion The therapeutic effect of PLDD combined with collagenase injection through a target location is stable for treatment of lumbar intervertebral disc herniation and better than that of PLDD or collagenase injection alone.
出处 《中华麻醉学杂志》 CAS CSCD 北大核心 2010年第12期1459-1461,共3页 Chinese Journal of Anesthesiology
关键词 减压术 外科 激光疗法 胶原酶类 椎间盘移位 Decompression, surgical Laser Therapy Collagenases Intervertebral disk displacement
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参考文献3

  • 1Wu Z, Wei LX, Li J, et al. Percutaneous treatment of non-contained lumbar disc herniation by injection of oxygen-ozone combined with collagenase. Eur J Radiol, 2009, 72(3) :499-504.
  • 2Cakir B, Schmidt R, Mattes T, et al. Index level mobility after total lumbar disc replacement: is it beneficial or detrimental? Spine (Phila Pa 1976), 2009, 34(9):917-923.
  • 3Bridges D, Thompson SW, Rice AS. Mechanism of neuropathic pain. Br J Anaesth, 2001,87( 1 ) : 12-26.

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