CT引导下靶点射频热凝联合臭氧消融术治疗腰椎间盘突出症的临床研究(1)

http://www.100md.com 2012年1月1日 唐接福 吴世行 舒文锋 满益旺 彭湘霖 曾捷 黄沙 唐永太 李永招

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     [摘要] 目的 观察CT引导下靶点射频热凝联合臭氧消融术治疗腰椎间盘突出症的疗效。方法 将120例腰椎间盘突出症患者随机分为3组,靶点射频热凝消融组(A组,n=40)、臭氧消融组(B组,n=40)、两者联合消融组(C组,n=40)。分别于术后1周、3个月和6个月进行疗效评价。结果 与术后1周相比,C组术后6个月的优良率显著提高(P<0.05);C组术后3个月及术后6个月的有效率及优良率均高于B组(P<0.05),C组术后6个月的优良率较A组高(P<0.05)。各组无明显术后并发症发生。结论 CT引导提高了穿刺的准确性,严格掌握适应证的情况下,靶点射频热凝联合臭氧消融术是治疗腰椎间盘突出症的一种安全、有效的方法。

    [关键词] 靶点射频热凝； 臭氧； 椎间盘突出； 微创

    [中图分类号] R323.3+3 [文献标识码] C [文章编号] 1005-0515(2012)-01-002-02

    Treatment of Lumbar Disc Herniation with CT Guided Ozone Injection and Target Ablation

    with Radiofrequency Thermocoagulation

    Tang Jiefu Wu Shixing Shu Wenfeng etal.

    (The Department of Orthopaedics the Second Hospital of Huaihua,Huaihua,418000,china)

    [Abstract] Objective To investigate the effects of target ablation with radiofrequency thermocoagulation and ozone injection in the treatment of lumbar disc herniation. Methods 120 cases of lumbar disc herniation patients were randomly divided into three groups (n=40): target ablation with radiofrequency thermocoagulation group (group A); ozone injection group (group B); target ablation with radiofrequency thermocoagulation and ozone injection group (group C). The rapeutic effects were evaluated on 1 week, 3 months and 6 months post-operation. Results Compared with the value on 1 week post-operation, the significant effective rate on 6 months post-operation in group C rost significantly (P<0.05); the effective rate and the evident effective rate on 3 months post-operation and on 6 months post-operation in group C were higher than that in group B(P<0.05), and the evident effective rate on 6 months post-operation in group C were higher than that in group A(P<0.05). No serious postoperative complications were observed. Conclusion CT guided treatment can greatly elevate the accuracy of puncture. If only the indications are carefully controlled, target ablation with radiofrequency thermocoagulation and ozone injection is a minimally invasive and markedly effective method for treatment of lumbar disc herniation.

    [Key words] Target ablation with radiofrequency thermocoagulation; Oxygen-ozone; Lumbar disc herniation; Mini-invasive

    腰椎间盘突出症是临床常见病,严重影响患者的工作和生活。该病治疗方法多样,射频消融术作为一种微创治疗方法,于2000年7月被FDA批准用于治疗腰椎间盘突出症[1],臭氧治疗椎间盘突出症已在欧洲得到了广泛的应用[2];我院自2007.09- 2010.03,在CT引导下对120例腰椎间盘突出症患者分别应用靶点射频热凝消融术、臭氧消融术及二者联合消融术治疗,取得良好的临床疗效,报告如下。

    1 资料与方法

    1.1 一般资料 本研究120例腰椎间盘突出症患者,男75例,女45例;年龄18-69岁，平均44.8岁。病程3个月-21年,平均3.8年;病变位于者L4/5者30例,L5/ S1者21例,L4/5及L5/ S1椎间盘同时突出者47例,合并其它椎间盘病变者22例。

    入院患者临床症状为腰部疼痛或下肢疼痛或两者皆有,均采用DR、CT或MRI检查,明确诊断。同意进行靶点射频热凝消融术和臭氧消融术治疗者列为研究对象,将患者随机分为3组,每组40例。A组行靶点射频热凝消融术;B组行臭氧消融术;C组行两者联合消融术。3组患者年龄、性别差异无显著性意义(P>0.05)。

    1.2 纳入和排除标准 手术严格按照纳入标准和排除标准进行,纳入标准:腰腿痛明显,严重影响工作和生活;经过2-4周正规保守治疗效果欠佳;CT或MRI检查证实椎间盘病变存在,突出物不超过椎管容积的30%;病变椎间隙大于邻近正常椎间隙的60% ......

    http://www.100md.com/html/paper/1005-0515B/2012/01/02.htm

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