臭氧与等离子射频消融术治疗慢性椎间盘源性腰痛对比研究

Contrastive Study of Ozone Ablation vs. Coblation Nucleoplasty for the Treatment of Chronic Discogenic Low Back Pain

【目的】比较臭氧及等离子射频消融技术治疗经保守治疗无效的慢性椎间盘源性腰痛的初步临床疗效。【方法】208例经保守治疗无效的慢性腰痛患者，术前椎间盘经造影显示为阳性，随机分别用臭氧射频消融术（A组）及等离子射频消融术（B组）治疗，其中A组95例：男47例，女48例，平均年龄35．5（17～55）岁，病程7～118个月；B组113例：男61例，女52例，平均年龄35．7（18～59），病程8～123个月；两组患者均于术前，术后1周及12个月时进行腰痛VAS评分，术后12个月时按照改良MacNab评分标准，评价两种方法的临床疗效。【结果】所有病例均顺利完成消融治疗，208例均获得随访，B组中1例无明显疗效，2例发生椎间盘炎，A组中1例无明显疗效，1例2个月时再次行臭氧射频消融术症状改善，无其他严重并发症发生。腰痛VAS评分，A组：术前为6．73±1．69分，术后1个月及末次随访时间分别为3．35±0．79分和1．55±0．37分，B组：术前为6．81±1．78分，术后1个月及末次随访时间分别为3．43±0．81分和1．66±0．43分，与术前比较差异均有统计学意义（P〈O．05），组间无明显差异。按照改良MacNab评分标准，术后12个月时，A组：优44例，良36例，可14例，差2例，优良率84．21％。B组：优39例，良54例，可17例，差2例，优良率82．30％。【结论】臭氧和等离子射频消融技术均是有效治疗椎间盘源性腰痛的微创、简单、安全的方法。

[Objective]To compare the preliminary clinical efficacy of ozone ablation vs. coblation nucleoplasty for the treatment of chronic discogenic low back pain failing to the conservative treatment. [Methods]208 patients with chronic discogenic low back pain who failed to conservative treatment and were positive with preoperative discography were randomly treated with ozone ablation and coblation nucleoplasty, respectively. The ozone ablation group（ n =95） included 47 males and 48 females, and were 17~55 years old（average 35.5 years old）, and their course was 7~118 months with an average of 30.8 months. The coblation nucleoplasty group（ n ： 113） included 61 males and 52 females, and were 18~59 years old（average 35.7 years old）, and their course was 8~123 months with an average of 35.7 months. Visual analogue scale（VAS） was evaluated before operation, 1 and 12 months after operation. The clinical outcomes of two therapeutic methods were assessed lpy modified Macnab criteria 12 months after operation. [Results] The ablation therapy was performed successfully in all cases. Totally 208 patients were followed up. In coblation nucleoplasty group, 1 case had no obvious efficacy, and discitis occurred in 2 cases. In ozone ablation group, 1 case had no obvious efficacy, and 1 case were treated by ozone ablation again 2 months after operation and then improved. No other serious complication occurred. All patients in two groups were followed up for 3~ 18 months with an aver- age of 7.8 months and 7.9 months, respectively. The VAS score of low back pain in ozone ablation group before operation, at 1 month and the last time after operation were 6.73±1.69, 3.35±0.79 and 1.55±0.37, respectively, and those in coblation nucleoplasty group were 6.81± 1.78, 3.43±0.81 and 1.66±0.43, respectively. There was significant difference between before and after operation（ P 〈0.05）, but there was no significant difference between two groups. According to the modified Macnab criteria, 39 patients were excellent, and 17 were good and 2 were poor in the ozone ablation group 12 months after op- eration, and the effective rate was 84.21%. In the coblation nucleoplasty group, 39 patients were excellent, and 54 were good and 2 were poor, and the effective rate was 82.30 %. [Conclusion] Both ozone ablation and coblation nucleoplasty are minimal invasive, simple, safe and effective method for the treatment of patients with discogenic low back pain.