臭氧治疗腰椎间盘突出症:盘内臭氧分布与疗效

Treatment of Lumbar Disc Herniation with O_3 Injection: Correlation of O_3 Distribution Pattern in Disc with Therapeutic Effect

目的 分析臭氧 (O3 )治疗腰椎间盘突出症中O3 在腰椎间盘内的分布与疗效的关系。资料与方法 腰椎间盘突出症患者 6 8例 ,用 2 1G酒精针穿刺病变椎间盘并注射浓度为 40 μg/ml的O3 气体 8～ 10ml,术后立即行CT扫描观察椎间盘内O3 气体的潴留及分布情况。所有患者随访超过 18个月。分析椎间盘内O3 情况与疗效之间的关系。结果 术后立即CT扫描显示气体在椎间盘内呈气湖状、裂隙状、小泡状或不定形状。按MacNab腰腿痛手术评价标准 ,显效者 32例 ,有效者 19例 ,无效者 17例。 46例气体呈散在分布 ,2 2例呈聚集分布 ,前者疗效优于后者 (P <0 .0 5 ) ;42例在突出或膨出的髓核组织之内可见单个或串珠状气泡分布 ,其疗效优于 2 6例突出或膨出的髓核组织之内无气体者 (P <0 .0 1)。而纤维环完整与不完整病例之间、盘内气体潴留量不同病例之间的疗效无显著差异 (P >0 .0 5 )。结论 疗效与O3 气体在椎间盘内的分布特点有关 ,而与潴留量及纤维环完整与否无关。因而选择合适的注射器材、运用适当的注射手法可以提高疗效 ;纤维环完整与否在O3 治疗中不宜作为病例选择的标准。

Objective To discuss the correlation of the O 3 distribution pattern in disc with the therapeutic effect in the treatment of lumbar disc herniation with O 3 injection.Materials and Methods Sixty-eight patients with lumbar disc herniation were subjected to O 3 injection into lumbar disc through a 21G needle. The concentration of O 3 was 40μg/ml and the volume 8～10 ml. CT scanning was immediately carried out after the injection to observe O 3 distribution in the discs. All patients were followed up over 18 months. The correlation between O 3 distribution pattern in the disc and therapeutic effect was studied.Results On CT scans, the accumulated O 3 in the disc took the form of lake, crack, bubble or irregular shape. According to MacNab criteria, excellent results were seen in 32, good in 19 and poor in 17 patients. Forty-six patients showing scattered O 3 distribution in the disc had better effect than that of the remaining 22 patients who showed compacted O 3 distribution in the disc (P<0.05). Air bubble in protruded or bulged nucleus pulposus was found in 42 cases, who had better effect than that in the remaining 26 patients who showed no air bubble in protruded or bulged nucleus pulposus (P<0.01). No significant difference in therapeutic effect existed between patients with intact and broken annulus, also between patients with different air volume in discs (P>0.05). Conclusion The O 3 distribution pattern in the disc well correlates with the therapeutic effect, while both accumulated O 3 volume in the disc and the integration of the fibrous annulus show no correlation with the therapeutic effect. Proper injection needle and injection skills are key points to achieve a successful result. The integration of the fibrous annulus is not a consideration in selecting suitable patient for O 3 injection therapy.