介入法侧隐窝胶原酶融盘治疗腰椎间盘突出症

Injection of Collagenase into Vertebral Lateral Recess for Patients with Lumbar Disc Herniation

目的通过C臂X光机影像引导下,介入法穿刺腰椎侧隐窝,行腰椎脊髓麻醉实验后,探讨侧隐窝局部注射胶原酶(胶原蛋白水解酶)治疗腰椎间盘突出症的安全性、有效性。方法 86例腰椎间盘突出症患者,椎间盘突出部位左侧46例,右侧36例,双侧4例。其中L4～5椎间盘突出45例,L5～S1椎间盘突出39例,L4～5、L5～S1双椎间盘突出2例,均经患侧小关节内侧缘穿刺进入硬膜外侧隐窝,先行硬膜外造影证实,再行腰椎脊髓麻醉实验呈阴性后,局部缓慢注入胶原酶1200 U(2 ml)。结果所有患者均无不良反应发生,溶盘后症状、体征在2周内明显改善,2周及1年优良率分别为80.2%和88.5%,有效率分别为96.5%和96.2%。结论介入法腰椎硬膜外侧隐窝穿刺造影及注射胶原酶治疗腰椎间盘突出症方法安全可靠,定点准确而个体化,操作简单而损伤小,易于基层医院推广。

Objective To explore the safety and efficacy of collagenase injection into vertebral lateral recess for the lumbar disc herniation（LDH）.Methods Eighty six cases with LDH were enrolled in this study.46 were with left part herniation,36 cases with right part herniation,and 4 cases with bilateral herniation.45 cases were with L4-5 intervertebral disc herniation,39 cases with L5-S1 disc herniation,2 cases with L4-5 and L5-S1 double disc herniation.The lumbar vertebral lateral recess was punctured through ipsilateral inner margin of small joint guided by C-arm X-ray machine and epidural angiography.After a negative lumbar spinal anesthesia,the collagenase 1200 U（2 ml） was injected into the lumbar vertebral lateral recess.Results All of the patients were without the adverse reaction.Dissolve nuclear symptoms and physical signs were obviously improved in 2 weeks.The excellent and good rate was 80.2% in two weeks and 88.5% in one year,respectively;the effectively rate was 96.5% in two weeks and 96.2% one year,respectively.Conclusion The lumbar spinal epidural lateral recess puncture,with a accurate and individualized dot,angiography and injection of collagen enzyme is a safe and reliable curative method for the LDH.It is easy to be generalized.