胶原酶；化学溶盘术；神经根；损伤____

胶原酶溶盘术后早期神经根病损临床与实验研究

http://www.100md.com 《中国矫形外科杂志》 2006年第11期

胶原酶；化学溶盘术；神经根；损伤,,胶原酶；,化学溶盘术；,神经根；,损伤,1材料、方法及结果,2实验部分,3讨论,参考文献：

     摘要：[目的]探讨胶原酶溶盘术后早期出现神经根病损原因，寻找胶原酶溶盘术后出现早期神经根病损预防与处理方法。[方法]临床回顾分析本院2000年1月~2004年12月开展的腰椎间盘突出症胶原酶溶盘术1 280例，其中早期出现神经根病损病例12例(发生率094%)。实验将18只日本大耳兔随机分为A、B、C组，A组为后纵韧带完整+盘内注射组，B组为后纵韧带破损+盘内注射组，C组为盘外(硬膜外腔)注射组，大体及光镜下观察不同时间椎间盘及神经根改变。[结果]临床资料表明腰椎间盘突出症胶原酶盘内+盘外溶盘组胶原酶使用剂量大，出现早期神经根损伤病例明显多于其他组(P<005)；12例早期出现神经根病损病例中，10例约在溶盘术后7 d内出现；8例术中均未见明显神经根压迫；随访4~30个月，症状有不同程度好转，但无1例痊愈，且3 d内手术治疗病例优良率明显高于8 d后手术治疗病例。动物实验显示胶原酶对髓核有明显溶解作用，B组(后纵韧带破损组)神经根出现明显损害，C组(盘外注射组)椎间盘内未见明显溶解，亦未见神经根损害。[结论](1)胶原酶溶盘中间产物和残余髓核溢入椎管可导致神经根损害症状，大剂量的盘内外联合溶盘可加剧神经根损害的发生率，对后纵韧带、纤维环破裂、髓核突入椎管的腰椎间盘突出症行胶原酶溶盘术应慎用；(2)胶原酶溶盘术后神经根损害预后差，预后与手术早晚明显有关；(3)胶原酶溶盘术后严格卧床，正确翻身，有助于降低神经根损害的发生率。

    关键词：胶原酶；化学溶盘术；神经根；损伤

    Clinical and laboratory study of early nerve foot lesion after collagenase chemonacleolysis∥ZHANG Bin,DAI MinDepartment of Orthopaedics Surgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006

    Abstract：[Objective]To investigate the etioloty of the early nerve root lesion(RNRL) after collagenase chemonucleolyoio(CC) and its prevention and treatment[Method]Twelvehundred and eighty case of lumbar disc herniation undergoint cc were reviewed and analyzedFrom January,2000 to December,2004 with followup time of 4~30 months,in which 12 cases(094%)had obvious ENRL after CCEighteen rabbits were randomly divided into three groups of six each:Group A,posterior longitudinal ligament intepated+intradisca injection;group B,parterior longitudinal ligamen+booteen+intradiscal injection,and group C,extradiscae injectionThe disc and the nerve roots at the inject side were removed,fixed and examined by microscope,and the changes of the discs end nerve roots were analyzed in different inject side and different time after CC[Result]As the collagenase dose was large in groups of intradiscal+intradiscal injections case of ENRL in this group were more than that in other groupsIn the 12 ENRL cases,ten cases of ENRL appeared in about 7 days after CC,8 cases without nerve root compression and all cases were improved in different degree,but no one reeovered completely at follow-up with excellent and good rate of efficiency in the cases operated in 3 days than that in cases operated after 8 daysIn the experiment rabbits,there lowed obvious lyeis of nucleusPulpus in group A and group B,with severe damage of nerve roots in group B,while in group C,there was no obvious lipis of nucleuss pulpus and damage of nerve roots[Conclusion](1)As the larger collagenas dose in the cases with intradiscal and extradiscal injections can raiseThe incidence of ENRL,it is suggested that CC used in cases with broken posterior longitudenal ligament of and brous anmulus and ,with nucleus pulpuses herniated into spinal canal,CC should be prudent to apply(2)The prognoseo of the ENRL after CC is poor and is related to operation time(3)The incidence of ENRL after CC can be lowered with absolute bed rest and changing body position after CC ......

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