盘外分次联合盘内单次注射胶原酶溶核术

CHEMONULEOLYSIS WITH INTERMITTENT EXTRA-DISC INJECTION AND SINGLE INTRA-DISC INJECTION OF COLLAGENASE

目的 :探讨盘外分次注射联合盘内单次注射小剂量胶原酶治疗腰椎间盘突出症的效果。方法 :30例以根性腰腿痛为主要表现的腰椎间盘突出症患者。在X线引导下 ,穿刺针经患侧小关节内侧缘或椎板外切迹进入硬膜外侧间隙 ,另一根针从后外侧入路至椎间盘内。确定针尖位置后 ,向硬膜外腔缓慢注入胶原酶 4 0 0IU/ 2ml,共 3次 ,每次相隔 30分钟 ,同时向椎间盘内一次性注入胶原酶 4 0 0IU / 1ml。结果 :溶核后根性症状在 1～ 2周内改善 ,在 1、2、4和 8周的显效率分别为 16 .7%、4 3.3%、5 3.3%和 6 6 .7%。 10例 1年后复查CT ,有 7例显示椎间盘缩小 ,其中 2例腰椎间盘突出物消失。结论 :在硬膜外侧间隙分次注射 。

Aim:To improve the effects of chemonuleolysis by epidural injection combined with a single intra disc injection of small doses of collagenase. Method: Thirty patients of lumbar intervertebral disc protrusion with sciatic pains were included in this study. A needle was inserted into extradural space of the protruded nucleus through the medial margin of inferior articulus, 400 units of collagenases (2ml) was injected slowly, it was repeated three times. Another dose of 400 units (1ml) of collagenases was injected into the center of the disc. Result: The VAS pain score was improved 1～2 week after chemonuleolysis. The rate of marked improvement was 16.7%, 43.3%, 53.3%, and 66.7% at first, second, fourth, and eighth weeks, respectively. Ten cases received CT scan one year following discolysis . The herniated discs were dissolved in 2 cases and reduced significantly in 5 cases. Conclusion: The current method bears a fine effect.