微創介入經皮穿刺椎間盤水刀應用的初步探討

Preliminary study of minimally invasive percutaneous hydrodiscectomy

目的對經皮椎間盤水刀減壓術的近期療效進行初步探討。方法對21例低位腰背痛並伴有放射性神經根性症狀的椎間盤突出症的患者,採用DSA介導下,經皮病變椎間盤穿刺,置入SpineJet(脊柱椎間盤水刀),設置10檔3分鐘2個週期利用高壓水流技術行髓核减壓。結果水刀治療腰椎間盤突出症21例患者,包括12個男性患者和9個女性患者。年齡為23歲~74歲,平均年齡為45.67歲。術前腰背痛和腿痛的VAS分別為7.14±1.50和8.50±1.20,術後1週腰背痛和腿痛的VAS分別為2.86±1.53(p<0.05)和2.41±1.12(p<0.05);Oswestry功能障礙指數(Oswestry Disability Index,ODI)問卷表術前爲71.43±14.93%,術後1週為28.57±15.26%(p<0.05)。結論經皮水刀治療腰椎間盤突出症以其治療效果確切、易於操作、創傷小和術後併發症少等優點,具有較好的臨床應用價值。但仍需大樣本長期的療效觀察。

Objective Preliminary discussion of early treatment outcome of percutaneous hydrodiscetomy.Methods 21 patients suffered from disc herniation presented with low back pain and radiating neuropathic symptoms were treated by DSA mediated percutaneous puncture of pathogenic disc and Spine Jet placement in the work channel,set 2cycles of speed level to 10(highest speed)for 3minutes to decompress the disc by using high pressure hydro-flow.Results the 21 patients includes 12 males and 9 females,ages ranging from 23 to 74 years(mean age is 45.67years old),pre-operation VAS(Visual Analogue Scale)of low back pain and lower extremity pain were 7.14±1.50 and 8.5±1.20 respectively,the VAS of low back pain and lower extremity pain decreased to 2.86±1.53(p<0.05)and 2.41±1.12(p<0.05)respective after 1 week of operation.Oswestry Disability Index(ODI)questionnaire in pre-operation were 71.43±14.93%,which decreased to 28.57±15.26%(p<0.05)after operation.Conclusion Percutaneous hydrodisectomy has important clinical value in treatment of lumbar disc herniation because of it’s simple minimally invasive technique and less side effects.But further large scale and long term studies should be performed to observe its long-term treatment effects.