CAJ | 학술논문

目的评价采用开放式低场MR导引,经小关节内缘入路椎间盘切割联合臭氧治疗后外侧型腰椎间盘突出症的可行性及疗效.方法经CT、MRI诊断为后外侧型椎间盘突出症患者103例,突出椎间盘共114个,其中L3～4椎间盘5个,L4～5椎间盘87个,L5～S1椎间盘22个,患者皆有明显的下肢放射性疼痛及麻木.在0.23 T开放式MR仪配合iPath 200光学追踪系统的导引下,自棘突旁经小关节内缘入路进针至椎间盘局限性后外侧突出处,再继续进针至中心髓核处.于椎间盘中心行椎间盘切割后注入60μg/ml O2-O3混合气体6 ml;后退针至椎间盘后外侧突出部分,对此部位进行重点切割并注入60 μg/ml O2-O3混合气体6 ml;继续退针至椎间盘外、侧隐窝内口即受压神经根处,注射镇痛混悬液4 ml、40 μg/ml O2-O3混合气体15 ml.所有患者分别于术后3 d、1个月、3个月、6个月进行随访,疗效评价依据改良的Macnab标准,并应用χ2检验分析不同时期有效率的差别.结果 103例患者中,术后3 d时有效率%.1%(99/103);术后1个月时有效率84.5%(87/103);术后3个月时有效率94.2%(97/103);术后6个月时有效率95.1%(98/103),有效率间差异有统计学意义(χ2=12.942,P=0.005),术中发生硬膜损伤5例(4.8%),术中、术后患者无明显不适.术后椎间隙感染2例(1.9%),经制动、理疗及抗生素治疗后痊愈.结论 MR导引小关节内缘入路椎间盘切割联合臭氧治疗后外侧型腰椎间盘突出症能够做到优势互补,创伤小、见效快、效果好.
목적 평개채용개방식저장MR도인,경소관절내연입로추간반절할연합취양치료후외측형요추간반돌출증적가행성급료효.방법 경CT、MRI진단위후외측형추간반돌출증환자103례,돌출추간반공114개,기중L3～4추간반5개,L4～5추간반87개,L5～S1추간반22개,환자개유명현적하지방사성동통급마목.재0.23 T개방식MR의배합iPath 200광학추종계통적도인하,자극돌방경소관절내연입로진침지추간반국한성후외측돌출처,재계속진침지중심수핵처.우추간반중심행추간반절할후주입60μg/ml O2-O3혼합기체6 ml;후퇴침지추간반후외측돌출부분,대차부위진행중점절할병주입60 μg/ml O2-O3혼합기체6 ml;계속퇴침지추간반외、측은와내구즉수압신경근처,주사진통혼현액4 ml、40 μg/ml O2-O3혼합기체15 ml.소유환자분별우술후3 d、1개월、3개월、6개월진행수방,료효평개의거개량적Macnab표준,병응용χ2검험분석불동시기유효솔적차별.결과 103례환자중,술후3 d시유효솔%.1%(99/103);술후1개월시유효솔84.5%(87/103);술후3개월시유효솔94.2%(97/103);술후6개월시유효솔95.1%(98/103),유효솔간차이유통계학의의(χ2=12.942,P=0.005),술중발생경막손상5례(4.8%),술중、술후환자무명현불괄.술후추간극감염2례(1.9%),경제동、리료급항생소치료후전유.결론 MR도인소관절내연입로추간반절할연합취양치료후외측형요추간반돌출증능구주도우세호보,창상소、견효쾌、효과호.
Objective To explore the value of MR imaging-guided percutaneous lumbar discectomy and discolysis with oxygen-ozone mixture for treatment of posterolateral lumbar disc herniation via a new puncture approach of facet joint medial route. Methods All 114 lumbar intervertebral discs in 103 patients were diagnosed as posterolateral lumber disc herniation by CT or MRI, which were located at the levels of L3-4 in 5 cases, LA-5 in 87 cases and L5-S1 in 22 cases. The procedure was guided under 0. 23 T open magnetic resonance with iPath 200 optical tracking system. A 14 G MR-compatible needle was punctured into the disc center via a new puncture approach of facet joint medial route. The therapy steps were as follows: firstly, cut nucleus pulposus and inject 6 ml oxygen-ozone mixture of 60 μg/ml in the disc center;secondly, retreat the needle to the local prominence, cut prominent part and inject 6 ml oxygen-ozone mixture of 60 μg/ml. Thirdly, retreat the needle to the periradicular nerve root, inject 15 ml oxygen-ozone mixture of 40 μg/ml and 4 ml pain-block liquid. All patients were followed up at 3 days, 1 month, 3 months and 6 months after operation, evaluated for the effect of treatment with the modified Macnab criteria, and the results were compared with the χ2 test. Results All procedures were successfully performed. Intraoperative dural injury occurred in 5 cases. Postoperative infection of intervertebral space occurred in 2 cases. The clinical effective rate was 96. 1% (99/103), 84.5% (87/103), 94.2% (97/103), 95.1% (98/103)respectively at 3 days, 1 month, 3 months and 6 months after operation, and the differences were signifieant (χ2 = 12. 942, P = 0. 005 ) . Conclusion MR imaging-guided percutaneous lumbar discectomy and discolysis with oxygen-ozone mixture via facet joint medial route is a minimally invasive, safety and effective method for the treatment of posterolateral lumbar disc herniation.