CT引导下联合靶位注射胶原酶治疗巨大型腰椎间盘突出症35例临床观察

目的研究CT引导下2靶位联合注射胶原酶治疗巨大型腰椎间盘突出症的效果、并发症及不良反应。方法巨大型腰椎间盘突出症（突出物≥10mm）患者35例，在CT引导下，Ⅰ型靶针达硬膜外间隙，Ⅱ型靶针通过工型靶针刺人突出物内，向突出物内注射胶原酶600U，向突出物表面注射胶原酶1200U。结果治疗结束后1周，1个月，3个月，6个月进行随访，按照改良MacNab方法进行评定，结果优24例（68．6％），良8例（22．8％），差3例（8．6％），优良率91．4％。治疗过程中全部患者无严重疼痛及症状加重，无神经根、血管等损伤。结论在CT引导下将胶原酶注射到椎间盘突出部位的硬膜外间隙与突出物内，是一种安全、有效的对巨大型腰椎间盘突出症的治疗方法，未见不良反应及严重并发症。

Clinical observation of collagenase injected into target directed by CT for treatment of giant lumbar intervertebral disc herniation

Objective To observe the efficacy,complications and side effects of collagenase injected into target directed by CT for treatment of giant lumbar intervertebral disc herniation. Methods Thirty five patients suffered from lumbar intervertebral disc herniation（protrusion ≥10mm） were collected. Directed by CT,type I needle was punctured into epidural space, then type 11 needle was punctured into the protrude through type Ⅰ needle. Collagenase 600U and 1200U were injected into the inside and the surface of the protrusion respectively. Results At 1 week, 1 month,3 months and 6 months after treatment the efficacy was evaluated according to modified MacNab method and the resuits were as following ： excellent 68.6 % （24 cases）, good 22.8 % （8 cases） and poor 8.6 % （3 cases）. No injury of spinal nerve roots and vessels and other side effects occured in all cases during the procedure of management. Concision It is an effective and safe method to inject collagenase into the epidural space and the inside of protrusion directed by CT for treatment of giant lumbar intervertebral disc herniation.