CT导引下硬膜外穿刺置管注射胶原酶治疗颈椎间盘突出症的临床探讨

The clinical effects of injecting collagenase by epidural puncture tube under CT guidance for the treatment of infervertebral disc prolapse

目的 探讨CT导引下硬膜外穿刺置管注射胶原酶治疗颈椎间盘突出症的临床疗效。方法 CT导引下硬膜外穿刺置管治疗颈椎间盘突出症37例 ,根据疗效评定标准 :优 :症状及体征完全消失 ,半个月后恢复原工作。良 :主要症状及体征消失 ,可维持原工作。可 :症状及体征有好转 ,能做轻工作。差 :症状与体征均无明显好转。术后随访3～9个月。结果 37例优18例、良16例、可2例、差1例 ,优良率91.89 %。术后3个月复查CT20例 ,15例突出颈椎间盘影像消失或明显缩小、5例突出椎间盘有不同程度缩小。无1例并发症发生。结论 CT导引硬膜外穿刺置管治疗颈椎间盘突出症具有影像直观 ,定位准确、优良率高等优点 。

Objective To investigate the clinical effects of injecting collagenase by epidural puncture tube under CT guidance for the treatment of cervical intervertebral disc prolapse. Methods 37 patients were enrolled in this study. The clinical manifestations after treatment were classified as:1.complete remission all clinical symptoms and signs disappeared,return to original work 2 weeks after treatment.2.Significant improvement most symptoms and signs disappeared,patients can maintain original work. 3.Improvement: improvements of symptoms and signs were observed and patients only can work non-strenuous. 4 No remission: no sign of improvements of symptoms three to nine months after operation Result 18 out of 37 patients completely recovered;16 patients significantly improved;2 patients partially responsed to the treatment while 1 patient did not have any responses to the treatment. The effective rate to the treatment is 91.89%. 20 patients were reexamined with CT three months after operation and obvious diminution of intervertebral disc screenage disappearance were found in 15 patients, partial diminution of intervertebral disc were observed in another 5 patients. There was no any significant side effect found in all the patients during follow up period. Conclusion inject collagen through epidural puncture tube under CT's guidance is a effective way for the treatment of cervical intervertebral disc prolapse. It has the advantage of direct screenage, accurate localization,and high rate of responses.