腰椎间盘内破裂的诊断与微创介入治疗|微创介入治疗
[摘要] 目的 探讨腰椎间盘内破裂的诊断和微创介入治疗方法。 方法 对38例顽固性腰腿痛患者，经腰椎间盘造影证实为腰椎间盘内破裂，对造影阳性椎间盘行射频热凝联合臭氧介入治疗，采用改良MacNab腰腿痛手术评价标准联合11点数字评分法（NRS-11）评定疗效。 结果 术后随访6～21个月，平均16个月，显效23例，有效13例，无效2例，治疗前、后11点数字评分，差异有统计学意义(P < 0.01)。 结论 腰椎间盘造影能定性诊断椎间盘内破裂，射频热凝联合臭氧介入治疗是椎间盘内破裂的有效治疗方法。
[关键词] 腰椎间盘内破裂；椎间盘造影；射频热凝；臭氧
[中图分类号] R681.5+3 [文献标识码] A [文章编号] 1674-4721（2012）07（c）-0065-02
Diagnosis and minimally invasive treatment of internal disc disruption
ZHANG Yingzheng1 ZHOU Liming1 CAI Hongchuan2 HAO Jisheng1 HE Qizhi1 CHEN Li1 XU Jun1
1.Department of Pain, Yuanwang Hospital of Jiangyin City in Jiangsu Province, Jiangyin 214431, China; 2.Department of Outpatient, Yuanwang Hospital of Jiangyin City in Jiangsu Province, Jiangyin 214431, China
[Abstract] Objective To study the diagnosis and minimally invasive treatment of internal disc disruption. Methods Thirty eight patients with refractory lumbago showed internal disc disruption by discography. Radiofrequency thermocoagulation combined with ozone interventional therapy was performed on the positive intervertebral disk; The therapeutic effect was determined by the modified MacNab criterion of lumbocrural pain operation and the 11-point numeric rating scale (NRS-11). Results All cases were followed-up for 6-25 months, averaging 16 months. Among the 32 cases, the therapeutic method was obviously effective in 20 cases, effective in 11 cases, ineffective in one case. There was a significant difference in the NRS-11 between pre and post treatment (P < 0.01). Conclusion Internal disc disruption can be diagnosed by lumbar diskography. The radiofrequency thermocoagulation combined with ozone interventional therapy is an effective treatment.
[Key words] Internal disc disruption; Discography; Radiofrequency thermocogulation; Ozone
慢性下腰痛是临床常见病及多发病，至今仍然是困扰人类医学难题之一，腰椎间盘已被认为腰痛的主要起源部位，腰椎间盘内破裂（IDD）是腰椎间盘病变的一种类型。本科病房近年来收治经普通保守治疗无效的顽固性腰腿痛患者，CT、MRI未见明显椎间盘突出，经椎间盘造影证实是椎间盘内破裂，行射频热凝结合臭氧介入治疗疗效满意，现分析报道如下：
1资料与方法
1.1 一般资料
本组38例，其中，男27例，女11例，年龄18～49岁，平均38.6岁。主要症状为顽固性腰腿痛，久坐、久卧或运动后加重，经针灸、理疗及硬膜外腔给药、口服止痛药物等治疗无效，其中有大腿疼痛或麻木者10例，小腿疼痛者1例， 母背伸肌力减弱1例。腰椎棘突间及椎旁可有压痛，腰椎活动度正常，直腿抬高试验阴性。患者常规查腰椎CT、X线片，其中16例行腰椎MRI检查，20个出现黑盘征，8个出现椎间盘后缘高信号区（HIZ）。本组CT、MRI均未见椎间盘突出及神经根受压，全部行腰椎间盘造影，造影后常规摄片、CT扫描。
1.2 方法
1.2.1 椎间盘造影与射频热凝联合臭氧介入治疗 患者侧卧，消毒、铺无菌巾单。由椎间孔入路穿刺进入椎间盘，透视侧位见针尖位于椎间盘中后1/3，正位见针尖位于间盘中间，注入造影剂，明确是否有精确症状再现椎间盘，即症状复制，认定责任椎间盘。1周后责任椎间盘穿刺成功后，连接射频仪（美国施乐辉ET-20S多功能射频仪）,射频仪显示一般阻抗在150～300 Ω之间，先予低频（2 Hz）（电压1.0～3.0 V）运动神经测试，无肌肉收缩现象，可证明热凝区域无运动神经存在，再予高频（50 Hz）（电压0.8～0.9～1.0 V）感觉神经测试，无下肢疼痛、麻木，可证明热凝区域无感觉神经存在，给予70～90℃每10℃射频治疗1次，每次1.5 min。射频热凝术后采用ROG-C2高浓度医用臭氧发生器（由陕西瑞博有限公司生产），抽取浓度为50 μg/mL 5mL反复冲击推注盘内。单纯破裂行破裂口定点治疗，弥漫破裂、完全破裂多点治疗。拔除穿刺针，无菌敷料帖敷穿刺点。回病房仰卧位12 h。