经皮靶点穿刺臭氧注射术治疗伴有纤维环后方高信号的腰椎间盘突出症

Treatment of Targeted Percutanous Ozone Ablation on Lumbar Disc Herniation with High Intensity Zone in Lumbar Disc Annulus Fibrosus

目的:观察采用经皮靶点穿刺臭氧注射术治疗伴有纤维环后方高信号(HIZ)的腰椎间盘突出症(LDH)的临床疗效。方法:136例伴有纤维环后方HIZ的LDH患者根据治疗方法分为2组:75例患者为经皮靶点穿刺臭氧注射治疗组(A组),61例患者为保守治疗组(B组)。A组患者在C型臂X光机引导下对靶点成功穿刺后注射浓度为40μg/mL的O_3~O_2混合气体2~5 mL。采用MacNab腰腿痛手术评价标准和Oswestry功能障碍指数(ODI)评分比较两组患者的治疗效果。结果:136例患者除24例外均获随访,时间18~44个月。在术后第1、2、3、6、9、12和18个月,根据MacNab腰腿痛手术评价标准,A组有效率分别为88.00%、90.67%、93.33%、89.39%、84.85%、78.13%和73.44%,B组的有效率分别为68.85%、62.30%、55.74%、61.82%、58.12%、54.17%和47.92%,各个时间点两组间比较差异均有显著性(P<0.05)。术后第12和18个月,A组ODI评分较低,两时间点组间比较差异无显著性(P>0.05),但与术前及B组比较差异均有显著性(P<0.05)。结论:经皮靶点穿刺臭氧注射是一种有效的治疗伴有纤维环后方HIZ的LDH的方法,其临床疗效比较稳定。

Objective： To observe the clinical effects of targeted percutanous ozone ablation on lumbar disc herniation （LDH） patients with high intensity zone （HIZ） in lumbar disc annulus fibrosus on MRI T2 weighted imaging. Methods： 136 LDH patients with HIZ in lumbar disc annulus fibrosus on MRI T2 were divided into two groups according to therapy methods. In group A, 75 patients were injected with 2-5 mL of 40 μg/mL mixture of 03 and 02 after targeted percutanous puncturing under the guidance of X-Ray machine with C-type arm. In group B, 61 patients were treated with conservative treatment. MacNab score criterion and Oswestry disability index （ODI） were used in assessment of the efficacy. Results： Except 24 patients, all the other cases were followed up for 18 - 44 months. At the postoperative 1st, 2nd, 3rd, 6th, 9th, 12th and 18th month, according to MacNab score criterion, the effective rates were respectively 88.00 %, 90.67 %, 93.33 %, 89.39 %, 84.85 %, 78.13 % and 73.44 % in group A and respectively 68.85 %, 62.30 % 55.74 %, 61.82 %, 58.12 %, 54.17 % and 47.92 % in group B. There were significant differences between two groups at the same time point （P〈0.05）. At the postoperative 12th and 18th month, ODI was lower in group A, and there was no significant difference between two time points （P〉0. 05）. But it was significant different with that preoperatively and in group B at the same time point （P〈0.05）. Conclusion： Targeted percutanous ozone ablation is an effective method with stable clinical efficacy in treating LDH with HIZ in lumbar disc annulus fibrosus on MRI T2 weighted imaging.