CT区域定位和X线引导下射频消融联合臭氧注射治疗腰椎间盘突出症的疗效比较

【目的】比较X线引导和CT区域定位经皮穿刺射频消融联合臭氧注射治疗腰椎间盘突出症（LDH）的临床效果。【方法12009年6月至2012年4月将采取在x线透视引导下行射频消融联合臭氧注射治疗LDH63例定为A组；将区域定位CT引导下行射频消融联合臭氧注射治疗LDH49例定为B组。依据视觉模拟疼痛评分（VAS）及Macnab评价标准评估治疗效果，观察术前、术后1周、3个月、12个月VAS评分及术后12个月优良率。【结果】两组术后VAs评分与本组术前比较均有显著下降（P〈0．05），术后1周、3个月、12个月两组VAS评分B组稍低于A组，但差异无统计学意义（P〉0．05）；术后各时段B组优良率均显著优于A组，差异有统计学意义（P〈0．05）。【结论】术前“区域定位”能够将椎间盘突出位置量化，准确把握适应证；术中CT引导能够为靶点射频热凝确定准确的穿刺路径及深度，使射频消融联合臭氧注射技术疗效最大化，对提高微创治疗LDH的优良率有重要临床意义。

Comparison in the Efficacy of CT Regionally Located vs X-ray Guided Radiofrequency Ablation Com- bined Ozone Injection for the Treatment of Lumbar Disc Herniation

Objective] To compare the clinical efficacy of X-ray guided vs CT regionally located percutaneous radiofrequency ablation combined ozone injection for the treatment of lumbar disc herniation. Methods]Totally 63 cases of lumbar disc herniation（group A） undergoing X-ray guided radiofrequency ablation combined with ozone injection and 49 cases of lumbar disc herniation（group B） undergoing CT regionally located radiofrequency ablation combined with ozone injection from June 2009 to April 2012 were analyzed retrospectively. According to visual analogue pain score（VAS） and Macnab evaluation criteria, the treatment efficacy was assessed. VAS score before and 1 week, 3 months and 12 months after operation and the excellent rate 12 months after operation were observed. Results] There was significant difference in VAS score of two groups between before and after operation（ P〈0.05）. There was no significant difference in VAS score at lweek, 3 months and 12 months after operation between two groups（ P 〉0.05）, but mean VAS score in group B was lower than that in group A. The excellent rate of group B at 12 month after operation was 91.8 % which was better than that of group A（73 % ）, and there was significant difference（ P〈 0.05）. Conclusion] Preoperative ＂regional location＂ can quantify the position of lumbar disc herniation and accurately grasp the indications. Intraoperative CT-guided radiofrequency can determine the exact puncture path and depth, and its excellent rate is better than X-ray guided group, and can maximize the efficacy of radiofrequency combined with ozone injection, and it is important to improve the excellent rate of minimally invasive treatment of lumbar disc herniation.