联合微创技术治疗腰椎间盘突出症的个体化选择

目的：探讨联合应用激光汽化减压（percutaneous laser disc discompression,PLDD）、射频热凝靶点消融、臭氧注射治疗腰椎间盘突出症的的个体化选择。方法：自2006年6月,在CT引导下选择性联合应用PLDD、射频和臭氧治疗腰椎间盘突出症患者267例,突出椎间盘的特点个体化选择穿刺路径和治疗方法;其中PLDD联合臭氧治疗92例（A组）,射频联合臭氧治疗67例（B组）,PLDD、射频和臭氧三者联合治疗108例（C组）。结果：所有患者均顺利完成手术,于术后1周、1个月,3个月及6个月随访记录VAS评分和Macanab优良率。三组患者VAS评分经方差分析,手术前、后有显著性差异（P〈0.05）,术后1周至6个月的VAS评分统计无显著性差异（P〉0.05）;术后三组间VAS评分、Macanab优良率比较无显著性差异（P〉0.05）。结论：选择性联合应用微创技术进行个体化的立体治疗,具有扩大微创手术适应症、提高手术疗效的优势,值得推广和利用。

Selectivity Individualization of Curing Lumbar Intervertebral Disc Protrusion by Combined Minimally Invasive Techniques

Objective：To investigate the selectivity and individualization of using percutaneous laser disc discompression （PLDD） and ozone injection combined with radiofrequency thermocoagulation and target ablation curing lumbar intervertebral disc protrusion.Methods：From June 2006,267 lumbar disc herniation cases were operated that guided by CT,the characteristic of the liable disc was confirmed by magnetic resonance imaging and CT before the procedure.92 cases（A group） were treated by PLDD combined with ozone injection,67 case were treated by radiofrequency thermocoagulation and target ablation combined with ozone injection,108 cases were treated by PLDD and ozone injection combined with radiofrequency thermocoagulation and target ablation.Results：All case been successfully operated,the theraptic effect was evaluated by comparing the value of VAS and excellent and good rate of therapy at preoperation and at 1 week,1month,3 months,6 months after operation.The value of VAS in three groups at postoperation were remarkably lower than preoperation（P0.05）.The excellent and good rate of therapy at 6 months was respectively 94.5%in group A,94.0%in group B and 95.4%in group C,no significant difference was observed between the three groups（P0.05）.Conclusion：The selectivity and individualization of using PLDD and ozone injection combined with radiofrequency thermocoagulation and target ablation curing lumbar intervertebral disc protrusion can enlarge the indication and improve the clinical curative effect,it should be spreaded in clinic.