注射胶原酶治疗腰椎间盘突出症的复查CT表现与注射技术的对比研究

A comparison of technique and CT follow-up for collagenase to treat lumbar disc herniation

目的 研究注射胶原酶治疗椎间盘突出症的复查 CT表现与注射胶原酶技术的关系。方法 均在 CT引导下注射胶原酶 ,1突出物表面注射 12 0 0 U胶原酶 (溶于 5 ml生理盐水中 ) ;2盘内注射 12 0 0 U胶原酶 (溶于 2 m l生理盐水中 ) ;3突出物内和表面联合注射其中突出物内注射 2 0 0U胶原酶 (溶于 0 .33ml生理盐水中 ) ,突出物表面注射 10 0 0 U胶原酶 (溶于 3ml生理盐水中 )。经过近期 3w内和远期 3个月至 2年对 5 4例进行 CT复查。结果 1突出物表面注射溶解率低 ( 2 0 %) ;2盘内注射溶解确切 ,但近期椎间盘或伴突出物体积明显变大使突出物进一步突出 ,导致疼痛等临床症状恶化 ;3突出物内和表面联合注射 :溶解率高 ( 92 .5 %) ,近期突出物体积变大不明显 ,疼痛等临床症状也不明显。结论 突出物内和表面联合注射胶原酶治疗椎间盘突出症是溶解率高、并发症少的技术方法 ,是注射胶原酶治疗椎间盘突出症的成功关键。

objective A comparison of technique and CT follow-up for collagenase to treat lumbar disc herniation.Methods Injection of collagenase under CT-guided in our groups,①Injection of collagenase to the surface of prominence of herniated lumbar disc:collagenase 1200U in 5ml isotonic physiological saline;②intradiscal collagenase:collagenase 1200U in 2ml isotonic physiological saline;③Combined injection of collagenase:collagenase 200U in 0 33ml isotonic physiological saline in the prominence of hernited lumbar disc,collagenase 1000U in 3 ml isotonic physiological saline to the surface of prominence of herniated lumbar disc.54 cases by CT follow-up after injection of collagenase in the near future(in 3 weeks)and long-dated(3 months to 2 years).Results ①Injection of collagenase to the surface of prominence of herniated lumbar disc:dissolve rate smaller (20%);② Intradiscal collagenase dissolve excellent,but volume become bigger of lumbar disc and the prominence in the near future that lead to prominence of hernited lumbar disc outer responsible for a worsening of the clinical symptoms.③Combined injection of collagenase:dissolve rate high (92 5%),invisible volume increase of lumbar disc herniated the prominence in the near future;responsible for a reducing of the clinical symptoms.Conclusion Combined injection of collagenase for treatment of lumbar disc herniation is a method of dissolve rate high and reducing of the clinical symptoms,less complication.