胶原酶溶盘术治疗中老年颈椎病的近远期效果及其机理

Short and Long-term Effects of Collagenase in the Treatment of Elderly Cervical Disc Disease and Relevant Mechanisms

目的:观察胶原酶治疗颈椎病的近、远期疗效并探讨其机理。方法:将本科2000年1月-2000年12月已行颈硬膜外腔注射胶原酶治疗并得到回访的75例颈椎病患者,按年龄分为老年组(56～74岁)40例和中年组(40～55岁)35例。经C7-T1间隙正中入路行硬膜外穿刺置管,并注入1.2%利多卡因5mL(内含地塞米松5mg)。观察30min,无脊麻现象,将胶原酶1200单位稀释至8mL,缓慢注入颈硬膜外腔。根据中华人民共和国中医药行业标准中医骨伤科痛证诊断疗效标准中颈椎病的疗效评价标准评定。结果:老年组和中年组1年、5年、10年优良率分别为77.50%、90.00%、82.50%和82.85%、88.57%、91.43%。2组疗效比较差异无统计学意义(P>0.05)。中年组1年与5年、10年疗效比较差异有统计学意义(P<0.05),5年与10年疗效比较差异无统计学意义(P>0.05)。结论:颈硬膜外腔注射胶原酶治疗中老年颈椎病患者均有很好的疗效。并呈随年限增长疗效更好的趋势。

Objective：To explore the short and long-term effects of collagenase in treating elderly cervical disc disease and the mechanisms involved.Methods： Seventy-five patients with cervical spondylosis who were treated with cervical epidural injection of collagenase treatment in 2000, were divided into older-age group （56 to 74 years old, 40 cases） and middle-age group （40 to 55 years old, 35 cases）. Catheterization and 1.2% 5ml lidocaine injection （containing dexamethasone 5rag） were performed through the C7-T1 epidural space midline. No spinal anesthesia was observed 30 min later, and then 1200 units of collagenase （diluted to 8ml） were slowly injected into the cervical epidural space. The efficacy was evaluated. Results：The excellent rate of 1-year, 5-year and 10-year in older-age group was 77.50%, 90.00%, and 82.50% and in middle-age group was 82.85%, 88.57%, and 91.43%. No significant difference was found between the two groups. There was no remarkable difference among older-age group. In middle-age group, the 1-year excellent rate was statistically different from that of 5-year and 10- year rate, while the difference between 5-year and 10-year rate was not statistically significant. Conelusion..Cervical epidural injection of collagenase treatment is effective for cervical spondylosis in the elderly, and the efficacy tends to be better with longer years of follow-up.