椎间盘内注射胶原酶治疗腰椎间盘突出症的影响因素分析

目的通过在X线监视下椎间盘内注射胶原酶治疗腰椎间盘突出症的疗效比较分析,研究影响疗效的相关因素。方法对接受椎间盘内注射胶原酶治疗的168例腰椎间盘突出症患者,通过复诊和电话询问,在注射后1周、3个月、1年分别评定疗效,然后分析椎间盘突出的大小、类型、数量及椎管狭窄对疗效的影响。结果椎间盘内注射胶原酶治疗腰椎间盘突出症的优良率在注射后1周、3个月、1年分别为22.62%、89.29%和92.26%;7例患者接受手术,占4.17%;注射后第3天1例发生马尾神经受压。发现椎间盘突出的大小对疗效影响不明显;注射后1周椎间盘突出型组较膨出型组疗效好(P<0.01),3个月和1年时疗效相近(P>0.05);3个月后多个椎间盘突出组较单个椎间盘突出组疗效差(P<0.05),1年后前者较后者疗效差(P<0.01);各时段非椎管狭窄组疗效均好于椎管狭窄组(P<0.01)。结论椎间盘内注射胶原酶治疗腰椎间盘突出症的疗效确切;椎管狭窄对疗效影响明显;膨出型疼痛反应时间较长;突出过大仍要慎用此法;单个椎间盘突出疗效好。

Study of related factors of the therapeutic efficacy of chemonucleolysis under X-ray monitoring for treatment of lumbar disc herniation

Objective To study the related factors of intradiscal injection of collagenase. Methods One hundred and sixty eight patients with lumbar disc herniation were injected with collagenase(600U) under X ray monitoring. Assessment of efficacy of the treatment was made in 1 week, 3 months and 1 year follow up. The parameters such as the size, the type and the number of herniated disc were studied. The effect of stenosis was also analyzed. Results The overall success rate after 1 week, 3 months and 1 year following the therapy was 22.62%, 89.29% and 92.26% , respectively. Seven patients were treated with surgical operation during the follow up, 1 developed cauda equina syndromes at the third day after the injection. It was found that the size of herniation did not affect the efficacy of the treatment. The protruded disc got better result than bulge disc after 1 week following the chemonucleolysis ( P <0.01). Patients with only one disc herniated had a better outcome than those with more than two discs herniated ( P <0.05) after 3 months ( P <0.01). The total effective rate in patients without stenosis was higher than that in patients with stenosis. Conclusion Intradiscal injection of collagenase is effective in treatment of lumbar disc herniation. The spinal stenosis can affect the treatment negatively. The herniation larger than 10mm is better to be surgically operated.