高渗盐水注射治疗腰椎间盘突出症

Intradiscal therapy with 10% hypertonic saline for lumbar disc herniation

目的 观察高渗盐水注射治疗腰椎间盘突出症的疗效、并发症及椎间盘组织的变化。方法 局麻下作椎间盘造影 ,然后椎间盘内注入 10 %高渗盐水 1.0～ 2 .5ml。结果 临床试验共 2 6 2例 ,2 5 5例获得平均 4年随访。最终疗效优 93例 ,良 10 0例 ,合计有效率为 75 .7%,注射后改善率为 71.5 %,对突出型、非游离的脱出型椎间盘突出有疗效。复发 13例 (6 .7%)。无并发症发生。 2 6例因注射无效施行手术 ,术中见神经和椎间盘周围组织未因注射发生变化。注射无效的原因是髓核明显脱出、游离或合并椎管狭窄症。组织学观察髓核发生类似酶作用后的变化 ,但椎间盘损害远比用胶原酶注射治疗轻微。结论 10 %高渗盐水椎间盘内注射治疗腰椎间盘突出症有效、微创、安全。

Objective A clinical trial of intradiscal injection of hypertonic saline to treat lumbar disc herniation, and observation of its effect, complications and changes in intervertebral disc tissue were performed for clinical application. Methods Discography was performed under local anesthesia, followed by a single injection of 1.0～2.5 ml 10% hypertonic saline. Results 262 cases were included in the study, with 4 years of average follow up. The final outcome ranked excellent in 93 cases and good in 100 cases. As a whole, the effective rate was 75.7% and the improvement rate was 71.5%. The procedure was effective in protrusion and confined extrusion types. 13 cases (6.7%) relapsed after the injection. No complication occurred. 26 cases resorted to surgery because of failure in intradiscal therapy, but no change was found, in the nerve and surrounding tissue of the intervertebral disc attributable to the injection during the surgical operation. The main causes of failure were the marked protrusion or non-contained extrusion, or the combination with spinal canal stenosis. Changes in the nucleus pulposus shown microscopically were similar to those resulted by the action of enzyme injection, but the injury to the disc was much milder.Conclusions Intradiscal therapy with 10% hypertonic saline for lumbar disc herniation is effective, mini-traumatic and safe.