微创腰椎间盘分流术治疗椎间盘源性腰痛

 目的 探讨微创腰椎间盘分流术治疗椎间盘源性腰痛的作用机制并分析其近期临床疗效。方法 通过体外实验测定尼龙线分流虹吸管作用的距离；动物椎间盘内置入尼龙线，其尾端埋于肌肉中，组织学检查尼龙线的生物相容性。15 例经椎间盘造影诊断为椎间盘源性腰痛，局麻下行腰椎间盘分流术（应用特别设计的工具将尼龙线置入腰椎间盘内），L_3-4 1 例、L_4-5 6 例、L₅S₁ 7 例、L_3-4合并 L_4-51 例。术后 1 周、3、12 和 24 个月采用疼痛视觉模拟评分（visual analogue scale， VAS）、Oswestry 功能障碍指数（Oswestry disability index，ODI）和影像学检查综合评估临床疗效。结果 体外实验显示通过尼龙线可将乳酸溶液的 pH 值从低于 4.0 调高至 7.14；体内实验表明绵羊椎间盘置入尼龙线后，椎间盘内蛋白多糖的含量随着时间推移逐渐增加，且尼龙线周围无炎症反应。所有患者均成功施行腰椎间盘分流术，无手术并发症。术后 2 年随访，患者 VAS 评分与 ODI 评分均有明显下降，VAS 改善率达 79.16%±12.33%，ODI 改善率为 77.42%±12.20%；X 线片示术后2 年椎间盘高度指数与术前相比，差异无统计学意义；MRI 示根据改良 Thompson 分级，分流椎间盘的退变程度无加重，10 例患者髓核信号有一定程度的增强。结论 经皮腰椎间盘分流术能够明显缓解腰痛，改善腰背部功能，具有创伤小，风险低的优点，有望成为临床治疗椎间盘源性腰痛一种新的微创手术方式。

Treatment of discogenic low back pain by minimally invasive lumbar disc shunt

Objective To study the mechanism of minimally invasive lumbar disc shunt on treating discogenic low back pain, and analyze its short-term clinical outcome. Methods First, use nylon suture to perform a shunt study about its ability to change acid fluid’s PH. Second, evaluate the influence of proteoglycan’s content preand post-nylon suture implanting into lumber disc of sheep, meanwhile, observe nylon suture’s biocompatibility inside of lumbar disc. Third, a clinical trial is performed , which is named“disc shunt”. Fifteen patients were diagnosed as discogenic low back pain by discography. All of them accepted“disc shunt”through pathway of discography at once, local anesthesia was used in all cases. Patients had shunts (using nylon suture) implanted into the following level of discs: one at _3-4，six at L_4-5，seven at L₅S₁，and one at both L_3-4 and L_4-5. Clinical outcome evaluation is based on VAS score, ODI score and radiology at one week, three months, one year and two year after implantation. Results In virto study showed pH of lactic acid solution was gradually raised from 4.0 to 7.14 after shunt by nylon suture. Shunted discs of sheep were harvested at one, three, twelve and twenty-four months. Safranine O staining showed gradually increasing of proteoglycans in disc. No obvious inflammatory reaction surround nylon suture after 24 months observation. Nylon suture’s biocompatibility was satisfactory inside lumbar disc. For clinical trial study, the low back pain and disability was significantly improved after operation. At the final twenty-four months follow up, evaluations showed all of the patients’VAS and ODI scores were reduced significantly，average rate of VAS scores improvement was 79.16%± 12.33%, and average rate of ODI was 77.42%±12.20%. Radiological examinations after implant showed no reduction of disc height index, and no aggressive disc degeneration according to Thompson scale. In addition, shunted discs were whitened under MRI, probably from disc hydration through the disc shunts. Conclusion Percutaneous disc shunt is an efficacious therapy for discogenic low back pain with multiple advantages such as being minimally invasive, having few risks, reducing pain and disability, and having treatment concurrent with diagnostic discography.