“弯针穿刺”在高髂嵴L_5S_1间盘突出症射频髓核消融术中的应用

Application of “Curved Needle Puncture” Radiofrequency Ablation in the Treatment of Lumbosacrum Disc Herniation with High Iliac Crest

目的:观察"弯针穿刺"在高髂嵴L_5S_1椎间盘突出症射频消融髓核成形术中的应用疗效。方法:随机纳入本科2016年7月至2017年6月间确诊的L_5S_1椎间盘突出症96例,其中髂嵴高于L5上终板者为高髂嵴病例组31例,髂嵴低于L5上终板者为低髂嵴病例组65例,前者以"弯针穿刺"后,行经皮低温等离子射频消融髓核成形术,后者以常规直针穿刺后行相同术式。通过采用术前、术后疼痛视觉模拟评分(VAS)及腰椎功能MacNab评定标准,评估两组患者术后疗效。结果:高髂嵴病例采用弯针穿刺、低髂嵴病例采用常规直针穿刺,除1例高髂嵴病例外,均成功抵达消融靶点,两组VAS及MacNab评分与术前比较差异有统计学意义(P<0.05),疗效确切。二者组间比较,差异无统计学意义(P>0.05),疗效相当。结论:应用"弯针穿刺"于高髂嵴L_5S_1间盘突出症的髓核消融术中,可切实克服常规直针难以达到靶点的技术困难,并达到与低髂嵴病例组常规穿刺手术相近的临床疗效,可操作性较强,值得应用推广。

Objective：To observe the effect of ＂curved needle puncture＂ technique in radiofrequency ablation nucleoplasty for lumbosacrum disc herniation with high iliac crest. Methods： 96 patients with lumbosacrum disc herniation diagnosed in our department from July 2016 to June 2017 were randomly enrolled. Among them, iliac crest was higher than Ls upper endplate in 31 cases, iliac crest lower than L5 upper endplate in 65 cases. The former was performed by percutaneous ra- diofrequency ablation nucleoplasty after ＂curved needle puncture＂, while the latter was performed by the same procedure after conventional puncture. The therapeutic efficacy of two groups were assessed and compared through preoperative and postoperative VAS score and MacNab assessment criteria. Results： Except for one case of high iliac crest, the two groups were successful in reaching the ablation target and there were significant differences in VAS and MacNab scores before and after operation in the two groups （P〈0. 05）. There was no significant difference between the two groups （P〉 0.05）. Conclusion：The ＂curved needle puncture technique＂ followed by radiofrequency ablation nucleoplasty operation used for lumbosacrum disc herniation with high iliac crest, can effectively overcome the difficulty of conventional tech- nique to reach the target of ablation, and achieve the clinical efficacy of conventional technique in low iliae crest group, and is worthy of application and popularization.