CAJ | 학술논문

目的探讨经皮激光汽化减压联合靶点注射胶原酶治疗腰椎间盘突出症的效果.方法拟行椎间盘松解术的腰椎间盘突出症患者90例,年龄31～52岁,体重58～70 kg,随机分为3组:经皮激光汽化减压组(P组,n=29)、靶点注射胶原酶组(C组,n=31例)和两种方法联合治疗组(PC组,n=30).P组光纤经穿刺针达病变椎间盘后进行激光汽化减压;C组在CT扫描下调整针尖位置,固定于突出物表面后注入胶原酶400～600 U,继续进针刺入突出物后注入200～300 U;PC组在激光汽化减压完成后行靶点注射胶原酶溶解术.于术前、术后7、30、60、90 d采用改良日本骨科学会下腰痛分级(M-JOA)评价疗效.结果与术前比较,P组和PC组术后各时点M-JOA分级升高,C组术后30、60和90 d升高(P＜0.05),术后7 d差异无统计学意义(P＞0.05);与术后7d比较,P组术后30 d M-JOA分级降低(P＜0.05),术后60、90 d差异无统计学意义(P＞0.05),C组和PC组术后30、60和90 dM-JOA分级明显升高(P＜0.05);与PC组比较,P组和C组术后各时点M-JOA分级明显降低,近期疗效分级降低.结论经皮激光汽化减压联合靶点注射胶原酶治疗腰椎间盘突出症疗效稳定,优于两者单独应用.
목적 탐토경피격광기화감압연합파점주사효원매치료요추간반돌출증적효과.방법 의행추간반송해술적요추간반돌출증환자90례,년령31～52세,체중58～70 kg,수궤분위3조:경피격광기화감압조(P조,n=29)、파점주사효원매조(C조,n=31례)화량충방법연합치료조(PC조,n=30).P조광섬경천자침체병변추간반후진행격광기화감압;C조재CT소묘하조정침첨위치,고정우돌출물표면후주입효원매400～600 U,계속진침자입돌출물후주입200～300 U;PC조재격광기화감압완성후행파점주사효원매용해술.우술전、술후7、30、60、90 d채용개량일본골과학회하요통분급(M-JOA)평개료효.결과 여술전비교,P조화PC조술후각시점M-JOA분급승고,C조술후30、60화90 d승고(P＜0.05),술후7 d차이무통계학의의(P＞0.05);여술후7d비교,P조술후30 d M-JOA분급강저(P＜0.05),술후60、90 d차이무통계학의의(P＞0.05),C조화PC조술후30、60화90 dM-JOA분급명현승고(P＜0.05);여PC조비교,P조화C조술후각시점M-JOA분급명현강저,근기료효분급강저.결론 경피격광기화감압연합파점주사효원매치료요추간반돌출증료효은정,우우량자단독응용.
Objective To investigate the efficacy of percutaneous laser disc decompression(PLDD)combined with injection of collagenase through a target location for treatment of lumbar intervertebral disc protrusion.Methods Ninety patients with lumbar intervertebral disc protrusion scheduled for discolysis,aged 31-52 yr,weighing 58-70 kg,were randomly divided into 3 groups: PLDD group(group P,n = 29),collagenase injection group(group C,n = 31),PLDD combined with injection of collagenase through a target location group(group PC,n = 30).The puncture was performed under the guidance of CT.Group P was treated using PLDD.Group C was treated with collagenase injection.Group PC was treated with injection of collagenase after PLDD was completed.The therapeutic effect was assessed before operation and on day 7,30,60 and 90 after operation using M-JOA score.Results M-JOA grade was significantly higher at the each time point after operation in group P and PC,and on day 30,60 and 90 after operation in group C than that before operation(P ＜ 0.05).M-JOA grade was significantly lower on day 30 after operation in group P,while higher on day 30,60 and 90 after operation in group C and PC than that on day 7 after operation(P ＜ 0.05).M-JOA grade was significantly lower at the each time point after operation in group P and C than in group PC.Conclusion The therapeutic effect of PLDD combined with collagenase injection through a target location is stable for treatment of lumbar intervertebral disc herniation and better than that of PLDD or collagenase injection alone.