CT引导下激光联合胶原酶治疗腰椎间盘突出症的疗效分析

Efficacy of laser union collagenase injection under CT guidance in treatment of lumbar intervertebral disc protrusion

目的比较单纯应用靶点注射胶原酶及联合应用治疗腰椎间盘突出症的疗效。方法腰椎间盘突出症病人60例,随机分为2组,胶原酶组(A组n=30例)和联合组(B组n=30)。A组在CT引导穿刺成功确认无"脊麻"体征后注射胶原酶。B组在患者在激光汽化减压完成后行胶原酶化学溶解术。分别于术前、术后1、3、7、30、90天采用视觉模拟评分法(VAS评分)评价疼痛程度,参照中华医学会骨科分会脊柱外科组手术疗效标准评价疗效。结果B组术后3个月疗效优良率明显高于A组(P<0.05),两组病人的VAS评分组间比较术前差异无统计学意义(P>0.05),术后1、3天A组VAS评分明显高于B组(P<0.05),术后7、30、60、90天两组VAS评分组间比较术前差异无统计学意义(P>0.05)。两组病人的VAS评分组内比较A组术后1、3天VAS评分明显低于术前,但高于其余各时点(P<0.05);B组术后各时点VAS评分明显低于术前(P<0.05)。结论靶点注射胶原酶适用于纤维环破损较重,间盘内压力低,突出物较大且无钙化的患者。联合应用PLDD可显著提高疗效,降低并发症。

Objective To compare the efficacy of collagenase injection and combination treatment for protrusion of lumbar intervertebral disc.Methods 60 Patients with protrusion of lumbar intervertebral disc were divided into 2 groups.Group A（n=30） was treated by collagenase injection under CT guidance which used to confirm there was no symptom of spinal anesthesia,Group B（n=30） was treated firstly by percutaneous laser disc decompression（PLDD）,then by chemical dissolving with collagenase.The pain severity before and after treatment was evaluated with VAS pain score on the day of 1,3,7,30,90 after treatment.Results The efficacy of group B is significantly better than group A 3 months after treatment（P〈0.05）.There was no statistical difference in the VAS score between two groups before treatment（P〉0.05）.The VAS score of group A is higher than that of the group B 1 or 3 days after treatment（P〈0.05）.There were no statistical differences between group A and B 7,30,60 or 90 days after treatment（P〈0.05）.VAS scores of group A 1 or 3 days after treatment were lower than that before treatment,but higher than other time points in this study（P〈0.05）.VAS scores of group B were significantly lower than that before the treatment（P〈0.05）.Conclusion Collagenase injection is indicated for the patient with severe damage of lumbar annulus fibrosis,low pressure inside the intervertebral disc,big protrusion and no calcification.The combination of collagenase injection and PLDD can increase the treatment efficacy significantly and lower the possibility of complication.