椎管侧隐窝针内针盘内外联合溶盘术治疗腰间盘突出症的临床研究

目的　比较单纯盘外注射胶原酶和盘内外联合注射胶原酶治疗腰间盘突出症的疗效。方法　选择240 例腰间盘突出症病人随机分成两组,每组120 例,在C臂X线引导下,A组病人经小关节内侧缘行侧隐窝穿刺,盘外注射胶原酶,B组病人在A组的基础上,自硬膜外针套入腰穿针行盘内穿刺,经椎间盘造影证实位置准确后,盘内注射胶原酶,实现盘内外联合注射,观察近、远期疗效,CT复查情况。结果　A、B组2 周疼痛缓解率分别为似33.3%、73.3%(P<0.01),3 个月优良率分别为80.8%、91.7%(P<0.05),6个月优良率分别为86.7%、97.5%(P<0.01),6 个月后CT复查,A组突出椎间盘体积变化不明显,仅密度降低,B组椎间盘突出物消失5例,突出物缩小(≥2 mm)11 例。结论　盘内外联合注射胶原酶治疗腰间盘突出症临床效果明显高于单纯盘外注射胶原酶,CT复查突出物消失或明显缩小,穿刺径路一次完成,创伤小,安全有效。

Clinical study on therapy of the intervertebral disc protrusion by intra-combined extra-discolysis through recessus lateralis with sprotte needle

Objective To compare therapeutic efficacy of simple extra-disc and intra- conbined extra- disc collagenase injection for lumbar intervertebral disc protrusion.Methods 240 patients suffering from lumbar intervertebral disc protrusion were divided into two groups randomly(n=120 for each). Guided by X-ray, lateral recessus puncture was carried out through inside edge of joint and injected collagenase in group A. In group B, after lateral recessus puncture, intra-disc puncture were taken by a lumbar Sprotte-G24 needle. When discography showed the needle was placed in the disc properly, injected collagenase again. Short-term and long-term effect were observed.Results Percentage of pain remission in Group A and group B were 33.3% and 73.3% respectively 2 weeks later (P< 0.01 ); 80.8% and 91.7% 3 months later (P< 0.05 ); 86.7% and 97.5% 6 months later (P< 0.01 ). CT examination showed protrusions of group A didn't change apparently , only density decreased 6 months later; protrusion disappeared in 5 cases, and shrinked in 11 cases in group B.Conclusion The clinical effect of intra- conbined extra- disc collagenase injection is excellent than simple extra-disc collagenase injection. CT examination showed protrusion disappeared or shrinked obviously and puncture can be carried out just one time, trauma is tiny, safe and effective.