Disc-FX经皮髓核钳夹、射频消融术与椎间盘内亚甲蓝注射术治疗椎间盘源性腰痛的对比研究

COMPARISON OF CLINICAL OUTCOMES OF PERCUTANEOUS DISCECTOMY COMBINED WITH RADIOFREQUENCY ABLATION BY DISC-FX SYSTEM WITH METHYLENE BLUE INJECTION IN TREATMENT OF DISCOGENIC LOW BACK PAIN

目的 比较Disc-FX系统经皮髓核钳夹、射频消融术与椎间盘内亚甲蓝注射术治疗椎间盘源性腰痛的临床疗效.方法 2010年3月-2011年2月收治椎间盘源性腰痛患者40例,随机分成2组,每组20例,Ⅰ组行椎间盘内亚甲蓝注射术,Ⅱ组行Disc-FX系统经皮髓核钳夹、射频消融术.对2组患者术前,术后3d、3个月、6个月和12个月时Oswestry功能障碍指数（Oswestry disability index,ODI）、视觉模拟评分（visual analog scores,VAS）及末次随访时MacNab评分进行对比分析.结果 所有患者均获得随访,随访时间16～27个月,平均19.3个月.随访期间未发现手术相关并发症.2组术后3d、3个月、6个月、12个月ODI和VAS与术前比较均明显降低,差异有统计学意义（P＜0.05）;2组间术前、术后3d ODI及VAS差异无统计学意义（P＞0.05）;术后3个月、6个月、12个月时Ⅱ组ODI和VAS较Ⅰ组降低更明显,差异有统计学意义（P＜0.05）.结论 Disc-FX系统经皮髓核钳夹、射频消融术与椎间盘内亚甲蓝注射术治疗椎间盘源性腰痛均可取得满意的临床疗效,但Disc-FX系统经皮髓核钳夹、射频消融术的近期和中期疗效与椎间盘内亚甲蓝注射术相比更加明显.

Objective To compare the clinical outcomes of percutaneous discectomy combined with radiofrequency ablation by Disc-FX System with methylene blue injection in disc for discogenic low back pain.Methods Forty patients underwent surgery either by methylene blue injection in disc （20 patients,group Ⅰ） or percutaneous discectomy combined with radiofrequency ablation by Disc-FX System （20 patients,group Ⅱ） using random number from March 2010 to February 2011.The theraputic effect was evaluated before and after operation by comparing Oswestry disablity index（ODI） and visual analgue scores（VAS） for discogenic low back pain patients.Results All patients were followed up for 16 to 27 months,with an average of 19.3 months.there was no major complication with patients.The postoperative VAS and ODI were significantly lower than preoperative in both groups （P ＜ O.05）.There was no significant difference between the two groups before operation and 3 d after operation （P ＞ 0.05）.The VAS and ODI of 3 months,6 months and 12 months after operation in group Ⅱ were significantly lower than those of group Ⅰ （P ＜ 0.05）.Conclusion Percutaneous discectomy combined with radiofrequency ablation by Disc-FX System and methylene blue injection in disc can achieve a satisfactory clinical effect for discogenic low back pain.But percutaneous discectomy combined with radiofrequency ablation by Disc-FX System was better than methylene blue injection in disc in short and medium term effect.