激光针刀联合微创介入治疗LDH的CT定量IPP图像变化比较

Comparison of CT Quantitative IPP Images in the Treatment of Laser Needle Knife and Minimally Invasive Intervention for Lumbar Disc Herniation

目的通过对激光针刀联合微创介入治疗腰椎间盘突出症的CT影像学图像变化的定量研究,从而评价该法对退变性腰椎间盘突出症患者的生物力学影响并探讨其作用机制,为该病的治疗开创了新的思路。方法将符合纳入标准的180例患者随机分为激光针刀组、微创介入组和联合组,每组各60例。激光针刀组采用激光针刀治疗,微创介入组采用微创介入等离子射频联合胶原酶溶核术治疗,联合组采用激光针刀联合微创介入治疗。治疗结束后,采用IPP图像软件,测量并比较3组患者的椎间盘CT图像突出物面积、突出程度、间隙高度、椎体滑移度,所有数据均采用SPSS19.0统计软件统计并进行统计学分析。结果治疗后CT定量图像特征变化比较,联合组及微创介入组突出物面积及突出程度较治疗前明显降低,差异均具有统计学意义(P<0.05),而激光针刀组未见明显变化;联合组与微创介入组均能够减小腰椎的滑移度,且联合组减小幅度更加明显,而激光针刀组未见明显变化;3组患者椎间隙高度治疗前后未见明显变化(P>0.05)。结论激光针刀联合微创介入治疗腰椎间盘突出症可有效减小突出物面积,降低突出程度,并减小腰椎滑移度。

Objective To have the quantitative study on CT imaging changes in the treatment of laser needle knife and minimally invasive intervention for lumbar disc herniation( LDH) so as to evaluate the biodynamic impact of this therapy for degenerative LDH and explore its effect mechanism and open a new approach to the treatment of this disease. Methods The enrolled 180 cases according to the inclusive criteria were randomized into a laser needle knife group,a minimally invasive intervention group and a combined therapy group,60 cases in each one. In the laser needle knife group,the laser needle knife therapy was used.In the minimally invasive intervention group,the minimally invasive intervention of plasma radiofrequency and collagenase chemonucleolysis( CCNL) were adopted. In the combined therapy group,the therapeutic methods in the previous two groups were used in combination. At the end of treatment,IPP image software was used to measure and compare CT image protrusion area,protrusion degree,gap distance and vertebral shifting degree of the intervertebral disc among the three groups. SPSS19. 0 was used for statistical analysis on all of the data. Results After treatment,in comparison of CT quantitative image characteristic changes,the protrusion area and degree in the combined therapy group and minimally invasive intervention group were reduced apparently as compared with those before treatment,indicating the significant difference( P < 0. 05). The changes were not obvious in the laser needle knife group. The lumbar vertebral shifting degree was reduced in the combined therapy group and minimally invasive intervention group,in which the reducing amplitude in thecombined therapy group was much more apparent. The changes were not obvious in the laser needle knife group. The change in gap distance was not apparent in the three groups( P > 0. 05). Conclusion The combined therapy of laser needle knife and minimally invasive intervention effectively shortens protrusion area and degree as well as vertebral shifting degree in LDH.