经皮腰椎间盘旋切术联合胶原酶溶解术和臭氧髓核消融术治疗腰椎间盘突出症【摘要】目的: 总结经皮腰椎问盘旋切术联合胶原髓核溶解术、臭氧髓核消融术治疗腰椎间盘突出症的操作方法和疗效观察。
方法:128例腰椎间盘突出患者进行治疗,共计205个椎间盘,其中L3~4 2例;L4~5 21例;L5 ~S1 5例;L3~4 ,L4~5 42例;L4~5 ,L5~1 28例;L3~4 ,L5~5 12例;L3~4 ,L4~5 L5 ~S1 18例。
病变椎间盘其中包容型165个椎间盘,非包容型40个椎间盘。
包容型椎间盘突出在行PLD后,用1ml生理盐水溶解600u 胶原酶盘内注射,观察10分钟后经皮旋切套管针退至椎问盘处外骨板外像处。
抽取浓度为40ug/ml的臭氧5~10ml迅速注射,臭氧能在柱管内上、下移动为标准,既神经根旁注射臭氧。
非包容型突出在行PLD后,用5ml生理盐水溶解1200u 胶原酶注入到椎间盘内。
观察10min后抽取浓度为40ug/ml的医用臭氧10ml迅速注入椎间盘内。
根据症状缓解情况,如效果欠差一个月后再次行相对的椎间孔穿刺用4ml生理盐水溶解1200u 胶原酶注射到病变椎间盘相应的硬膜囊前间隙,有5例病人反复3次注射胶原酶,术后根据突出部位不同而采取不同的卧位。
结果:显效103例,占81.5%,其中包容型突出41例,非包容型突出62例;有效21例,占16.4%,其中包容型突出6例,非包容型15例;无效4例,占3.1%,均为非包容型突出。
结论:经皮椎间盘旋切除术联合胶原酶溶解术及臭氧髓核消融术进一步扩大了微创治疗腰椎间盘突出症的适应症,显著提高了疗效。
【关键词】放射学介入经皮腰椎间盘旋切术胶原酶胶原酶溶解术臭氧髓核消融术椎间盘移位Treating nucleus pulposus of lumbar disc by percutaneous lumbar disc surgery with peeling and ozone collagenase chemonucleolysis ablationXu Wenhua【Abstract】Objective:To evaluate the percutaneous lumbar nucleus circled resection combined collagen dissolved in surgery, ozone nucleus ablation treatment of lumbar disc herniation operation methods and efficacy. Methods:128 patients with lumbar disc herniation were treated with a total of 205 discs, including L3~4 2 Li;L4~5 21 Li; L5 - S1 5 cases; L3~4 , L4~5 42 Li; L4~5 , L5~1 28 cases; L3~4 , L5~5 12 Li; L3~4 , L4~5 ,L5 - S1 18 cases. Intervertebral disc disease in which an inclusive type 165 disc, 40 disc-type non-inclusive. Inclusion-type disc line PLD, the 600u dissolved with 1ml saline injection of collagenase plate, observed 10 minutes after the trocar through the skin peeling retreat vertebral disc Department, such as bone plates outside the office. Ozone concentration of 40ug/ml taking 5-10ml rapid injection of ozone in the column tube, the next move as the standard, both the nerve root next to the injection of ozone. Highlight the line of non-inclusive-type PLD, 1200u dissolved with 5ml normal saline injected into the intradiscal collagenase. Observed 10 minutes after taking a concentration of 40ug/ml rapid injection of medical ozone 10ml intradiscal. The basis of clinical symptoms to defuse the situation, such as the effect of line again after a month due to poor relative foraminal puncture 1200u collagenase dissolved with 4ml saline injected into the vertebral lesions. The corresponding inter-disc space before dural sac, 5 patients were repeated three times injection of collagenase, after taking different positions according to highlight a different supine. Results:103 cases markedly, accounting for 81.5%, of which 41 cases encompassing prominent, highlighted 62 cases of non-encompassing; effective in 21 cases, accounting for 16.4%, of which 6 cases encompassing prominent, non-inclusive type in 15 cases; invalid 4 cases, accounting for 3.1%, are non-inclusive-type prominence. Conclusion:Percutaneous disc surgery rotation combined collagenase chemonucleolysis and ozone nucleus of the minimally invasive ablation to further expand the indications for treatment of lumbar disc herniation, significantly improved efficacy.。
