经皮靶点髓核旋切减压联合臭氧多次注射治疗非包容性腰椎间盘突出症的疗效观察

EFFECACY OF PERCUTANEOUS TARGET NUCLEOTOMY ATHERECTOMY DECOMPRESSION COMBINED WITH OZONE INJECTION FOR TREATMENT OF NONINCLUSIVE LUMBAR INTERVERTEBRAL DISC HERNIATION

目的：观察经皮靶点髓核旋切减压联合臭氧多次注射治疗非包容性腰椎间盘突出症的疗效.方法：136例非包容性腰椎间盘突出症患者采用随机数字表法,随机分为两组,在CT引导下,A组68例应用Dekompressor髓核旋切器,经小关节内侧缘入路穿刺,行靶点髓核旋切腰椎间盘减压术.B组68例在A组旋切基础上经穿刺针管向盘内注入臭氧,最后经穿刺针管向盘内置入一次性硬膜外导管,埋置并固定,术后每天经导管向盘内注入50 μg/ml臭氧5～10ml,连用5d.通过治疗前和治疗后1、3、7d测定腰背、腿疼痛视觉模拟评分（visual analogue scale,VAS）、直腿抬高试验（straight leg raising test,SLRT）及治疗后1、6个月汉化功能障碍指数（oswestry disability index,ODI）评分来评价两组临床疗效.结果：A、B两组治疗后1、3、7 d VAS较治疗前明显降低,SLRT明显改善（P＜0.05）.术后1、6个月随访,B组疼痛VAS及汉化功能障碍指数评分均好于A组（P＜0.05）,特别是6个月VAS比较,差异有统计学意义（P＜0.01）.两组均无明显并发症发生.结论：经皮Dekompressor靶点髓核旋切减压和臭氧多次注射联合治疗非包容性腰椎间盘突出症安全、有效.

Objective：To evaluate the efficacy of percutaneous target nucleotomy atherectomy decompression combined with repeated ozone injection for treating non-inclusive lumbar disc hemiation.Methods：136 cases with non-inclusive prolapse of lumbar intervertebral disc were randomly divided into two groups.With the CT guidance,in group A the Dekompressor nucleus pulposus rotary cutting device was applied to the 68 cases,which underwent target nucleus pulposus rotary cutting disc decompression through puncture via inner margin of lumber facet.The 68 cases in group B received intradiscal ozone injection by the puncture needle.on the basis of rotary cutting as performed in group A,and finally implanted with the disposable epidural catheter through the puncture needle tube into the disc.The catheter was embedded and fixed,via which 5 ～ 10 ml ozone of 50 μg/ml was injected after the operation each day and continued for 5 days.The visual analogue score （VAS） of waist,back and leg pain at pre-treatment and on 1,3,7 day after treatment,straight leg raising test （SLRT） and oswestry disability index （ODI） scores on 1,6 month after treatment were used to evaluate the clinical curative effecacy between the two groups.Results：VAS were significantly decreased and SLRT improved significantly on 1,3,7 day after treatment in groups A and B,compared with those before treatment （P ＜ 0.05）.During the follow-ups on 1 month and 6 months after treatment,patients in Group B showed better VAS and ODI scores than those in Group A （P ＜ 0.05）,particularly for the scores on the 6th month,the differences were statistically significant （P ＜ 0.01）.No obvious complications occurred in the two groups.Conclusion：Percutaneous Dekompressor target nucleus pulposus atherectomy decompression and repeated ozone injection for treating non-inclusive lumbar disc herniation is safe and effective.