数字减影引导下椎间盘内注射医用三氧治疗颈与腰椎间盘突出症的疗效及机理

目的观察椎间盘内注射医用三氧对椎间盘突出症的疗效，并评估其对引起疼痛的炎性介质的影响，探索其作用机理。方法颈与腰椎间盘轻、中度突出症患者60例，均在数字减影下（DSA）行经皮椎间盘内穿刺注射25,μg／ml医用三氧20ml。根据疼痛视觉模拟评分量表（VAs）及止痛药使用情况、改良MacNab评价标准，于治疗前、治疗后1周、6个月时统计患者的临床症状缓解，并进行评价。应用酶联免疫吸附试验（ELISA）检测注射前、注射后1、4、12周时患者血清磷酯酶A2、组胺、5-羟色胺含量的改变。结果术后1周、6个月时患者VAS评分及止痛药使用评分明显下降，与术前比较差异均有统计学意义（P〈0．05）；术后7d与术后6个月时比较，总有效率分别为91．7％（55／60例）和95．0％（57／60例）；优良率分别为75．0％（45／60例）和78．3％（47／60例）。与术前相比，术后1、4、12周时患者血清磷酯酶A2、组胺、5-羟色胺含量明显下降，差异均有统计学意义（P〈0．05）。结论盘内注射医用三氧治疗颈与腰椎间盘突出症均获得了较好的临床疗效，医用三氧可降低椎间盘突出症患者血清磷酯酶A2、组胺、5-羟色胺含量。

Efficacy and mechanism of medical ozone intra-discai injection under DSA guidance in the treatment of patients with intervertebral disc herniation

Objective To investigate the clinical efficacy and mechanism of medical ozone intra- discal injection in the treatment of patients with disc herniation under DSA-guidance. Methods Six- ty patients with cervical or lumbar disc herniation were injected with medical ozone 25 μg/ml 20 ml under the guidance of DSA. VAS, dose of analgesic and the modified MacNab in all patients were ob- served and recorded before the treatment and 7 days and 6 months after the treatment. The levels of phospholipase A2 （PLA2）, hyaluronic acid （HA） and 5-HT in serum were detected by ELISA be- fore the treatment and at 1,4 and 12 weeks after the treatment, and the results were compared and analyzed. Results VAS and dose of analgesic both decreased significantly than those before the treatment （P〈0.05）. The total effective rate was 91.7%（55/60 cases） and 95.0%（57/60 cases） at 7 days and 6 months after the treatment respectively. The excellent and good rate was 75.0 % （45/60 cases） and 78.3% （47/60 cases） respectively. The results of ELISA showed that PLA2, HA and 5- HT levels were significantly decreased in serum at 1, 4 and 12 weeks after the treatment than those before the treatment. Conclusion The medical ozone intra-discal injection under DSA guidance is ef- fective for the treatment of patient with intervertebral disc hernialion and the levels of PI.A2, HA and 5-HT in serum is decreased after medical ozone injection.