不同介入方法治疗腰椎间盘突出症疗效比较

目的 采用不同的介入方法治疗腰椎间盘突出症,观察研究各种方法的治疗效果及特点。方法 将93例符合微创介入治疗适应征的腰椎间盘突出症患者,分别采用胶原酶髓核溶解术和经皮钕激光椎间盘汽化术介入治疗．在治疗前和治疗后1周、1个月,6个月、1年五个时段,对所有病例进行度节体感诱发电位(DSEP)检测。同时根据患者症状、体征恢复程度的评定标准．以优良率作为疗效指标．分别以术后1个月、1年作为早期和远期疗效评定,对所有病例的随访资料,通过统计学分析比较,研究两种治疗方法的疗效及特点。结果 经皮钕激光椎间盘汽化术与胶原酶髓核溶解术两种方法,对解除神经受压、恢复神经功能的早期疗效,无显著性差异．术后1个月两者的优良率分别为71％和66％;术后1年经皮钕激光椎间盘汽化术治疗的优良率为85％．显著高于胶原酶髓核溶解术(66％)。经过两种治疗方法后．神经电生理指标改善,潜伏期缩短,波幅延长,显示神经功能有所恢复。结论 经皮钕激光椎闻盘汽化术与胶原酶髓核溶解术,两种方法疗效确实、可靠。与胶原酶髓核溶解术相比,经皮钕激光椎间盘汽化术技术具有显效快、远期疗效好的特点。

Clinically comparative study on the treatment of different kinds of interventional procedure for lumbar disc herniation

Objective To observe and compare the outcome and clinical character in the patients of lumbar disc herniation treated by the no-vascular interventional procedure using DSEP and clinical outcome assessment scale. Methods 93 patients who had a diagnosis of lumbar disc herniation during Oct,2001-April,2003 utilizing the no-vascular interventional procedure under fluoroscopic guidance underwent performance of PLDD and CNL . Each patient was measured with dermatomal somato-sensory evoked potential(DSEP)on the time of pre-operation, 1 week, 1 month, 6 months and 1 year post-operation, latency and amplitude were documented. Patients were also established with outcome assessment of Zhonghua Orthopedic Association on the time of 1 month and 1 year post-operation classified in"Excellent, Good, Fair, and Poor" four grades. All the results were collected. The statistical analysis was performed with the SPSS statistical software system (version 10. 00, SPSS. ). Results All the patients were followed up until 1 year except 3 patients. The data of the patients who were followed up successfully were collected and analyzed statistically. There were no significant differences ( P <0. 05) between the success rates of CNL and PLDD in the time of 1 month post-operation (66% , 71% ). Compared with the CNL, the success rates of PLDD in the time of 1 year post-operation was higher significantly(66% , 85% ) . After operation, the latency was shorten and amplitude became higher. It indicated that function of lumbar nerve has been improved. Conclusion Both CNL and PLDD appear to be safe and effective treatment for herniated intervertebral disks. The outcome of PLDD is better than CNL. The outcome and clinical character of PLDD and CNL, can be evaluated objectively using the technique of DSEP.