经皮激光汽化颈椎间盘减压术的临床应用

目的评价经皮激光汽化椎间盘减压术（percutaneous laser disc decompression,PLDD）治疗颈椎间盘突出症的临床应用效果和应用前景。方法2003年3月-2005年12月,对47例颈椎间盘突出症患者96个椎间盘实施PLDD治疗。男25例,女22例;年龄37-72岁,平均56岁。突出椎间盘节段：单节段3例,多节段44例。C3、420个、C4、527个、C5、631个、C6、718个。通过激光对髓核组织的汽化,凝固减少髓核组织,降低椎间盘压力。激光汽化1次治疗3个椎间隙者5例,2个椎间隙者39例,1个椎间隙者3例。结果42例获随访3-31个月,平均13个月。疗效评价参考丁亮华等评定标准,优18例（42.9%）,良14例（33.3%）,中6例（14.3%）,差4例（9.5%）,有效率90.5%,优良率76.2%,无并发症发生。结论PLDD能有效缓解颈椎间盘突出症的症状和体征,创伤小、安全、有效。

CLINICAL APPLICATION OF PERCUTANEOUS LASER DISC DECOMPRESSION IN THE TREATMENT OF CERVICAL DISC HERNIATION

Objective To evaluate the clinical effect of percutaneous laser disc decompression(PLDD)in the treatment of cervical disc herniation.Methods From March 2003 to December 2005,47 patients with cervical disc herniation(96 cervical disc)were treated with PLDD.There were 25 males and 22 females with an average age of 56 years,ranging from 37 to 72 years.The lesion were located at the levels of C3,4 in 20 discs,C4,5 in 27 discs,C5,6 in 31 discs,C6,7 in 18 discs.The laser fiber was introduced into the center of the herniated disc space by percutaneous puncture from anterior neck surface under fluoroscopic guidance.Laser reduced the intra-disc pressure through the vaporization of disc nucleu.The adopted laser was semi-conducted with a wavelength of 810 nm.Each laser output power was 15 W with 1 s emission and 2 s interval.The total laser output power was decided depending on the degenerative degree of the disc and the reactive process of heat,ranging from 300 to 1 000 J.Results Of 47 patients,42 were followed up for 3 to 31 months(mean 13 months).The clinical evaluation was classified as excellent in 18 cases(42.9%),good in 14 cases(33.3%),fair in 6 cases(14.3%)and poor in 4 cases(9.5%).The general response rate was 90.5%.The excellent and good rate was 76.2%.No complications occurred.Conclusion PLDD can relieve the symptoms and signs of patients suffering from cervical disc herniation with less complication.The manipulation of PLDD is easy,safe and mini-invasive.