低温等离子射频消融治疗腰椎间盘突出症初步探讨

The primary clinical results of low temperature plasma radiofrequency ablation in patients with lumbar herniated disc

目的评价低温等离子刀射频消融术治疗腰椎间盘突出症的临床疗效。方法 2006年1月～2009年12月应用低温等离子射频消融治疗腰椎间盘突出症共44例,男20例,女24例;年龄30～52岁,平均40岁。局部麻醉,在C型臂引导下操作。共46个椎间隙:单间隙42例,双间隙2例。术后随访近期效果。结果全部病例均获得随访,随访时间6～48个月,平均24个月。VAS评分术前(8.40±0.50)分,术后1周(2.60±0.53)分,末次随访(2.80±0.34)分。Oswestry评分术前(59.00±1.90)分,术后1周(30.00±1.80)分,末次随访(34.00±1.50)分。各指标术后及末次随访时与术前比较有显著性差异(P<0.05或P<0.01),而术后两次随访差异无统计学意义(P>0.05)。患者满意度80%,无任何并发症。结论经皮低温等离子刀髓核消融术是治疗腰椎间盘突出症行之有效的方法,这种技术简单、微创、安全、疗效肯定。关键是选择合适的适应证。

Objective To evaluate the efficacy of low temperature plasma radiofrequency ablation technique in patients with leg pain caused by radicular encroachment.Methods All procedures were performed under local anesthesia and fluoroscopic guidance.Channels were created in the nucleus by advancing the radiofrequency probe（ablating） and withdrawing it（coagulation）.In all patients six channels were created.Forty - four consecutive patients with leg pain and magnetic resonance imaging evidence of small and medium - sized herniated discs correlating with the patient＇s symptoms were included.Treatment level includes 46 disc totally and there were single disc herniation in 42 cases,double in 2 cases.Results Patients were followed up for at least 6 month（6-48 months,averaged,24 months）.VAS pain score improved from 8.40±0.50 preoperatively to 2.60±0.53 postoperatively and was 2.80±0.34 at last follow up.Oswestry score improved from 59.00±1.90 preoperatively to 30.00±1.80 postoperatively and was 34.00±1.50 at last follow up. The patients＇ satisfaction was 80%.There were no complications related to the procedures.Conclusion Our results encourage us sure that nucleoplasty is a simple,safe,micro-invasive and good result in lumbar disc herniation treatment. The key of this methord is carefully selected patients with leg pain caused by radicular encroachment.We recommend applying this minimally invasive technique only in those patients with small contained disc herniations with annular integrity.