CT引导下化学消融术治疗腰椎间盘突出症的临床研究

摘要

目的 研究腰椎间盘化学消融术治疗腰椎间盘突出症(LD H)的临床疗效,为临床治疗提供参考.方法 把191例LDH患者分为A、B两组,在CT引导下行腰椎间盘化学消融术治疗LDH,A组(n=95)行盘内注射治疗,B组(n=96)行盘内盘外联合注射治疗,术后30、90、180 d通过门诊或电话等方式随访,参考M acnab疗效评定标准对患者做随访和统计分析.结果 两组分别于治疗结束后30、90及180 d进行门诊或电话随访,所有患者均未出现神经、脊髓损伤及椎间盘感染等并发症.视觉模拟评分法(VAS)评分系统,组内比较治疗前、后两组差异均有统计学意义(P<0.05),组间比较治疗后B组评分均低于A组(P<0.05).A组优良率术后30 d为81.1%(77/95),术后90 d为83.2%(79/95),术后180 d为85.3%(81/95);B组优良率术后30 d为85.4%(82/96),术后90 d为88.5%(85/96),术后180 d为91.7%(88/96).结论 C T引导下腰椎间盘微创介入化学消融术止痛效果良好、迅速,盘内外联合治疗疗效更好.%Objective To investigate the clinical effectiveness of chemoablation for the treatment of lumbar disc herniations (LDH) to provide reference for its clinical treatment .Methods A total of 191 cases of LDH were divided into the group A and B . All cases were performed the CT-guided chemoablation for treating LDH .The group A conducted the intra-disc injection treatment , while the group B conducted the intra-disc and extra-disc combined injection .The cases were followed up by the modes of outpatient department or telephone on postoperative 30 ,90 ,180 d .The follow up and statistical analysis were conducted by referring to the Macnab effect evaluation criteria .Results The two groups conducted the outpatient department follow up or telephone follow up on postoperative 30 ,90 ,180 d .All cases did not appear the complications such as nerve damage ,spinal cord damage and intervertebral disc infection .In the intra-group comparison ,the VAS score had statistical difference between before and after treatment ( P<0 .05) .In the inter-group comparison ,the score after treatment in the group B was lower than that in the group A (P<0 .05) .The good effect rate on postoperative 30 d in the group A was 81 .1% (77/95) ,which on postoperative 90 d was 83 .2% (79/95) and which on postoperative 180 d was 85 .3% (81/95) .The good effect rate in the group B was 85 .4% (82/96) on 30 d ,88 .5% (85/96) on 90 d and 91 .7% (88/96) on 180 d .Conclusion CT-guided lumbar intervertebral disc minimally invasive interventional chemoab-lation has good and rapid analgesic effect ,and the intra-disc and inter-disc combined treatment has better curative effect .