等离子刀联合臭氧髓核消融术治疗腰椎间盘突出症

Treatment of lumbar intervertebral disc herniation with coblation combined with ozone nucleus pulposus ablation

目的：比较等离子刀联合臭氧髓核消融术与等离子刀髓核消融术治疗单节段包容性腰椎间盘突出症的I临床疗效。方法：2009年6月至2011年6月收治单节段包容性腰椎间盘突出症患者64例，其中33例采用等离子刀联合臭氧髓核消融术治疗（A组），男19例，女14例；年龄20-60岁，平均（40．4±8．8）岁；病程12-38个月，平均（19．9±5．8）个月。31例采用等离子刀髓核消融术治疗（B组），男18例，女13例；年龄20-60岁，平均（39．8±7．3）岁；病程12-48个月，平均（19．2±8．1）个月。应用疼痛视觉模拟评分（visualanaloguescales，VAS）评估术后疼痛的分级及JOA评分评价术后功能改善率。结果：术后无神经根、马尾神经损伤及感染等并发症发生。两组VAS评分术后1个月差异无统计学意义（P〉0．05），术后12个月等离子刀联合臭氧髓核消融术（A组）痛疼减轻优于等离子刀髓核消融术（B组）。术后12个月，两组JOA评分比较差异无统计学意义（P〉0．05）。根据功能改善率评定疗效：A组，优9例，良21例，可3例，差0例；B组，优6例，良18例，可7例，差0例。等离子刀联合臭氧髓核消融术优良率优于等离子刀髓核消融术（P〈0．05）。结论：在短期内治疗单节段包容性腰椎间盘突出症的治疗中，等离子刀联合臭氧髓核消融术的治疗效果更好。

Objective：To compare the clinical effects between coblation combined with ozone nucleus pulposus ablation and single radiofrequency ablation of nucleus pulposus in treating a simple segment inclusive lumbar intervertebral disc herniation. Methods：From June 2009 to June 2011,33 patients with lumbar intervertebral disc herniation were treated with coblation combined with ozone nucleus pulposus ablation （group A）,including 19 males and 14 females,ranging in age from 20 to 60 years old with an average of （40.4±8.8） years old,in the course of disease from 12 to 38 months with an av- erage of （19.9±5.8） months;31 patients were treated with single radiofrequency ablation of nucleus pulposus （group B）,in- eluding 18 males and 13 females,ranging in age from 20 to 60 years old with an average of （39.8±7.3） years old,in the course of disease from 12 to 48 months with an average of （19.2±8.1） months. Visual analogue score （VAS） and JOA score system was respectively used to evaluate pain and function after operation. Results：All patients were followed up more than 1 year. No injuries of nerve root and eauda equina nerve,infection were found. There was no significant difference in VAS score between two groups at 1 month after operation （P〉0.05）, but at 12 months after operation,VAS score of group A was better than that of group B （P〈0.05）. There was no significant difference in JOA score between two groups at 12 months af- ter operation （P〉0.05）. According to the functional improvement rate to evaluate the clinical effects,in group A ,9 cases got excellent results, 21 good, 3 fair;and in group B, 6 excellent, 18 good,7 fair. Clinical effects of group A was better than that of group B （P〈0.05）. Conclusion：Clinical effects of coblation combined with ozone nucleus pulposus ablation is better in treating a simple segment inclusive lumbar intervertebral disc herniation.