重复注射胶原酶治疗腰椎间盘突出症

目的:探讨重复注射胶原酶治疗腰椎间盘突出症的疗效及安全性。方法:经过注射胶原酶治疗效果不理想的腰椎间盘突出症患者58例,重复注射胶原酶,观察疗效及影像学变化。L4,527例L5S131例;年龄20~61岁,平均42岁;男25例,女33例;病程2个月~5年,平均3·7个月。第1次注射到本次注射的时间平均为3·8个月。结果:根据疗效评价标准优46例,良5例,可2例,差5例。46例症状体征消失,患者术后1个月复查CT,原突出的椎间盘缩小2~6mm,平均3·4mm;余12例效果不理想的患者,术后1周复查CT,7例突出的椎间盘较术前大,5例椎间盘形态、体积无改变。此12例第3次溶盘术后其中10例症状体征消失,2例症状体征有所改善,其中1例行第4次溶盘术后症状进一步改善。27例CT显示有椎间盘出现真空征。复查CT突出的椎间盘溶解率73%,未发生过敏、感染、破坏、椎体滑脱等情况。结论:注射胶原酶治疗腰椎间盘突出症可以重复进行,适应证选择恰当可以彻底治愈此病,并且有较高的安全性。

Repetitive collagenase injection into spinal canal for the treatment of lumbar intervertebral disc herniation

Objective:To evaluate the clinical outcome and reliability of repetitive collagenase injection into spinal canal for treating lumbar intervertebral disc herniation.Methods:Fifty-eight patients with lumbar intervertebral disc herniation (25 male and 33 female;27 cases in L_ 4,5 ,31 cases in L_5S_1),which were failed treated by injected collagenase at first time.The age was 20-61 years with the average of 42 years and the follow-up time was 2 months to 5 years with the average of 3.7 months.The average time from 1st to 2nd injection was 3.8 months.These patients were again treated with collagengse injection into spinal canal,of which clinical results and CT image were observed.Results:According to evaluation criterion of effect,46 cases were excellent result,5 good,2 fair and 5 poor.The symptom and physical sign of lumbar intervertebral disc herniation vanished in the patients of excellent result,of which the protruded discs decreased 2-6 mm with mean of 3.4 mm in CT image after the second treatment.The CT showed that protruded disc in 7 cases was larger than pre-treatment and 5 cases had no change in 1 week after the second treatment.The patients(12 cases)with unsatisfied effect were re-treated with collagenase(the 3rd injection) and the symptom and physical sign of 10 cases vanished and 2 cases obtained improvement.Among the 2 cases,1 case were treated again(the 4th injection) and the symptom obtained better improvement.The CT showed intervertebral disc had vacuum syndrome in 27 cases and the deliquescent rate of protruded discs were 73%.No allergic reaction,infection,spinal slippage were found.Conclusion:Repetitive collagenase injection into spinal canal can be used for treating lumbar intervertebral disc herniation.The method is a safe and effective method to adaptive patients.