数字血管减影下经皮穿刺激光气化联合臭氧靶点注射治疗腰椎间盘突出症的临床观察

目的探讨数字血管减影（DSA）下经皮穿刺激光气化（PLDD）联合臭氧靶点注射治疗腰椎间盘突出症的疗效及安全性。方法回顾性分析69例腰椎间盘突出症患者，采用激光气化联合臭氧盘外靶点注射治疗。半导体激光器功率调至8W／12W，脉冲辐射时间1．0s，脉冲间隔时间1．0s，激光总能量一般控制在800～1500J之间。硬膜外病变部位旁注射50μg／ml的臭氧气体10-20ml。通过患者治疗前、治疗后1个月、3个月、6个月、12个月的视觉模拟疼痛评分（VAS）和改良的MacNab’s评价法观察其疗效。结果治疗后1、6、12个月的显效率分别为26．1％（18／69例）、69．7％（48／69例）、63．4％（44／69例），有效率分别为60．9％（42／69例）、24．6％（17／69例）、24．6％（17／69例），总有效率分别为87．0％（60／69例）、94．2％（65／69例）、88．4％（61／69例）。治疗后6及12个月的显效率较1个月时明显提高（P〈0．05）。所有患者均未发现严重并发症。结论数字血管减影下经皮穿刺激光气化联合臭氧靶点注射是治疗腰椎间盘突出症的一种安全、有效的方法。

Clinical therapeutic effect of percutaneous laser disc decompression and ozone injected at the target on lumbar intervertebral disc herniation under the guidance of digital subtraction angiography

Objective To analyze the therapeutic effect of percutaneous laser disc decompression （PLDD） and ozone injected at the target outside disc to treat lumbar disc herniation under the guidance of DSA. Methods A retrospective study was carried out. Sixty nine patients with lumbar disc herniation were treated by PLDD and ozone injection. PLDD was used to decrease the pressure inside disc, the total energy of laser was about 800-1 500 J, and then 10-20 ml ozone of 50μg/ml was injected. The clinical result was evaluated pre-treatment and 1, 3, 6, 12 month after treatment by VAS and MacNab＇s score. Results All patients were followed up 12 months. The excellent rate at 1, 6, 12 month after therapy was 26.1% （18/69 cases）, 69.7 % （48/69 cases）, 63.4 % （44/69 cases） respectivly. The effective rate at 1, 6, 12 month after therapy was 87.0% （60/69 cases）, 94. 2 % （65/ 69 cases）88.4% （61/69 cases） respectively. No complications occurred. Conclusion Percutaneous laser disc decompression with ozone injected at the target under the guidance of digital subtraction angiography is a better method for treatment of lumbar disc herniation.