射频消融技术在椎间盘镜下腰椎间盘摘除术中的应用

The application of radiofrequency ablation in miro-endoscopic discectomy

目的探讨射频消融技术在椎间盘镜（MED）下腰椎间盘摘除术中应用的临床疗效。方法分析自2011—12—2012—08采用MED椎间盘镜＋射频消融术治疗的单节段单纯腰椎间盘突出症40例，比较术前、术后3d、7d腰痛、腿痛VAS、JOA评分。结果本组获随访6～13个月，术前VAS腰痛、腿痛评分分别为（4．84±2．58）分、（7．59±2．17）分。术后3d（1．10±1．04）分、（2．50±2．35）分，术后7d（0．38±0．27）分、（1．66±1．20）分。术前JOA评分（9．15±2．58）分，术后3d（18．65±2．43）分，术后7d（20．70±2．34）分。术后各时间点腰痛、腿痛VAS评分，JOA评分与术前相比，差异均有统计学意义（P〈0．05）。术后3d与术前相比，腰痛、腿痛VAS评分平均改善3．74分（P〈0．05），5．09分（P〈O．05），JOh评分平均改善9．50分（P〈O．05）。术后3d与7d相比，腰痛、腿痛VAS评分平均改善O．72分、0．84分，JOA评分平均改善2．05分。所有患者末次随访时改良Macnab优良率为97．5％。结论在MED椎间盘镜下腰椎间盘摘除术中应用射频消融技术具有低温安全，可以有效清除突出髓核组织和破碎纤维环，进行纤维环固缩成形，临床疗效好。术后恢复快。

Objective To investigate the clinical outcome of radiofrequency ablation in miero-endoseopie discectomy（MED）. Methods Prospective analysis was performed on 40 patients receiving combination radiofrequeney ablation with MED for treatment of single level lumber disc herniation from December 2011 to August 2012 in our hospital. Visual analogue seale （VAS ,low baek pain and leg pain）, Japanese Orthopaedic Association Seores （JOA） were compared before operation and the third and seventh day after operation. Results All patients had 6-13 months follow-up. The VAS （low back pain, leg pain） were （4.84＋2.58）, （7.59＋_2.17）; （1.10＋_1.04）, （2.50＋2.35）; （0.38_＋0.27）, （1.66＋-1.20） before operation, and the third and seventh day after operation respeetively. Preoperative JOA was （9.15＋-2.58）, the third day after operation （18.65＋_2.43）, the seventh day after operation （20.70＋_2.34）. The differences in VAS and JOA before and after operation were statistically significant （P 〈0.05）. And differences were still statistically significant for each time after operation （P 〈0.05）. All eases were evaluated with the modified Macnab at the last follow-up, the excellent and good rate was 97.5%. Conelusion The radiofrequeney ablation is low temperature and safe, can effectively remove the herniated nueleus pulposus tissue and broken annulus fibrosus, and remold annulus fibrosus in micro-endoscopic diseectomy. As results, it exhibits good clinieal effect and quick postoperative recovery.