盘外泵注胶原酶治疗脱垂型腰椎间盘突出症的临床研究

A CLINICAL STUDY OF INJECTING COLLAGENASES TO THE DISC EXTERMAL TARGET POINT TO TREAT THE PROLAPSE OF LUMBAR INTERVERTEBRAL DISC

目的：回顾性分析本院2008年以来应用微量注射泵泵注胶原酶,盘外溶解治疗脱垂型腰椎间盘突出症的临床疗效。方法：经磁共振确认为L4~5和/或L5~S1间盘突出的36名患者,在DSA引导下经骶裂孔置入导管至腰椎间盘突出物所在的硬膜外腔,经导管推注3 ml造影剂证明位置正确。微量泵恒速泵注胶原酶,术后绝对卧床4周,采用视觉模拟评分法（visual analogue score,VAS）和改良Macnab评分判定治疗效果。结果：术后无1例发生突出物脱落;术后所有患者疼痛均有明显改善,3个月时优良率91.6%;复查腰椎MR显示突出物均有明显缩小。结论：经骶裂孔置入硬膜外导管恒速泵注胶原酶治疗腰椎间盘突出症有利于药物积聚于突出物周围,提高治疗的长期效果。

Objective： To observe the chemonucleolysis effects of collagnases injected into epidural space in the prolapse of lumbar intervertebral disc by retrospectively analyzing cases from the year of 2008. Methods： 36 patients were included. All of the patients were performed MR/and conformed with the L4-5 and/or L5 -S1 prolapsed disk. Then an epidural catheter was inserted into the target intervertebral space through sacral hiatus with DSA guidance. Diffusion of the contrast media in epidural space was observed after injecting 3 ml Omnipaque. 1200 u collagenases were injected into the epidural space by pump, and absolutely took postoperative bed rest for 4 weeks. The effects by using VAS and reformed Macnab therapeutic effect before and after the operation were evaluated. Results： There was no prominence abscission and all patients＇ pain and limb functions were distinctly improved. Excellent rate of after three months was 91.6%. MR/confirmed that herniated disc was dissolved in some cases. Conclusion： The method of after pump collagenases into the epidural space bears a safe and fine effect.