胶原酶溶解术治疗腰椎间盘突出症40例无效分析

目的　分析胶原酶溶解术治疗腰椎间盘突出症无效的原因及机理。方法　 1994-10～ 1999-10采用盘外硬膜前间隙注射胶原酶治疗腰椎间盘突出症 16 0 0例 ,在随访病例中 ,36例 3个月后症状、体征无改善。 4例 2周后行手术治疗。 40例疗效均判定无效 ,分类对比分析其无效的原因及机理。结果　 40例中 ,极外侧型突出 9例 ,无效原因为突出物在椎管外压迫脊神经 ;脱出并游离 3例 ,无效原因为胶原酶无法与游离椎间盘相结合 ;突出大于 1cm 6例 ,无效原因为溶解不完全或反应加重行手术治疗。手术后6例 ,突出伴钙化 8例 ,无效原因为患者的症状由手术后并发症或钙化部分压迫神经引起 ;单纯性突出 8例 ,无效可能与少见的原因或个体差异有关。结论　对于极外侧突出 ,脱出并游离为胶原酶溶解术的禁忌证 ,突出大于 1cm ,手术后及突出伴钙化 ,应具体分析患者的情况 ,胶原酶溶解术应慎用。

Lumbar Disc Herniation Treated with Chemonucleovsis(An Anylysis of Uneffective 40 Cases)

Objective To anylyse the uneffective causes of lumber disc herniation treated with chemonucleovsis and its mechanism.Methods Collagenase was injected outside the lumbar disc for treatment of lumbar disc herniation in 1600 cases from october 1994 to october 1999.Of them 36 cases were poor improvement clinically after 3 months,4 cases were underwent operation after 2 weeks.To classify and anylyse the uneffective causes and its mechanism.Results The extreme lateral lumbar disc herniation was in 9 cases,the uneffective cause was that the hernations repressed the spine nevers outside vertebra vessel.The herniation and free disc was in 3 cases,the uneffective cause was that the collagenase didn't unite with the herniation.The herniation was over 1 cm in 6 cases,the uneffective cause was that the chemonucleovisis weren't complete or the patients were operated.Of which the herniation after operation was in 6 cases,the herniation and calcification 8 cases,the uneffective cause was the consequent or that the calcification repressred the spine nevers.The simple herniation was in 8 cases,the uneffective cause was the less reason or the quality different.Conclusion Lumbar disc herniation treated with chemonucleovsis is uneffective for the axtreme lateral lumbar disc herniation or the herniation and free disc.The chemonucleovsis must be used carefuly for the herniation over 1 cm or the herniation after operation and herniatin with calcification.