经骶后孔穿刺硬膜外前间隙置管注药治疗腰椎间盘突出症

目的研究经骶后孔穿刺前间隙置管注射胶原酶治疗腰椎间盘突出症的可行性。方法腰椎间盘突出症患者45例，用硬膜外穿刺针，经第1骶后孔进针，穿刺人硬膜外侧隐窝。在X线透视下循前间隙置入带钢丝的硬膜外导管至椎间盘突出压迫处，经注药试验和造影确认穿刺到位后以微量泵泵入胶原酶1200U。观察穿刺成功的例数与治疗后15d评价患者疼痛缓解情况。结果应用此法在硬膜外前间隙置管45例全部成功。注射胶原酶15d后患者疼痛消除率60％（27／45例），缓解率40％（18／45例），总有效率100％（45／45例）。结论经第1骶后孔穿刺硬膜外置管可准确地到达硬膜外前间隙，能有效消除腰椎间盘突出症患者的疼痛。

Intubation and injection to the anterior epidural space via posterior sacral foramen for the treatment of lumbar intervertebral disc herniation

Objective To explore the possibility of puncturing, intubating and injecting colla- genase to the anterior epidural space via posterior sacral foramen for the treatment of lumbar interver- tebral disc herniation. Methods Forty-five patients with lumbar intervertebral disc herniation were received epidural puncture to the lateral recess through first posterior sacral foramen, then the epi- dural catheter was intubated to the target under X-ray, collagenase 1 200 U was pumped into epi- dural space after identification by injection trial and radiography. The number of successful cases was recorded, and pain relief was evaluated at 15 days after the treatment. Results All the cases were successfully intubated. The cure, improved and total effective rates were 60% （27/45 cases）, 40% （18/45 cases） and 100%（45/45 cases） respectively. Conclusion The anterior epidural space can be exactly punctured and intubated via first posterior sacral foramen for the treatment of lumbar inter- vertebral disc herniation after injecting collagenase.