摘要
目的通过对1192例腰椎间盘突出症患者实施胶原酶溶盘术后有残留症状者568例的分析,寻求术后残留症状的处理方法。方法本组有残留症状者占47．65％。其中盘内或盘外或盘内盘外同时注射者,术后残留症状发生率分别是49．40%、51．07%、22．96％。溶盘术后1个月仍有症状者复查CT共138例,椎间盘突出物消失或缩小50％以上者仅占30．43％。术后残留症状的处理:腰痛采用骶管或硬膜外阻滞配合脊神经后内侧支阻滞加针刀松解;神经根痛采用侧隐窝和椎间孔外口注射加针刀松解椎间孔外口;腰骶部僵硬采用棘间韧带、脊神经后内侧支、第三腰椎横突尖周围注射加针刀松解;患肢乏力、麻木采用弥可葆肌注、口服壮骨伸筋胶囊、维生素B1治疗。结果治疗后3个月、6个月、12个月对各种残留症状的疗效进行比较,差异均无统计学意义 (P>0．05),同时分别对每种类型残留症状在治疗后3个月、6个月、12个月疗效互相进行比较,差异也均无统计学意义(P>0．05)。结论胶原酶溶盘术后残留症状发生率较高,术后残留症状在治疗后3个月、6个月、12个月各种类型疗效基本相同,残留症状在治疗后3个月疗效基本稳定。
Objective To search for a methods of treating the postoperative remaining symptoms after collagenase chemonucleolysis through an analysis of 1192 cases with herniated intervertebral discs treated by collagenase chemonucleolysis. Methods There were 568 cases showing postoperative remaining symptoms ,which account for 47.65% of the total patients. In an exact way, internal intervertebral discs injection was 49. 40% , external intervertebral discs injection 51.07% , and internal and external discs injection 22. 96% of the total 1 192 patients respectively. One month after collagenase chemonucleolysis, there were still 138 cases remaining symptoms according to the reexamined results of CT. The number of herniated discs retracted by 50% or completely disappeared only accounts for 30. 43%. Four types on the basis of the different postoperative remaining symptoms were divided and treated： （ 1 ） patients suffering from lowback pain were treated with hiatus sacralis epidural block or lumbar epidural block, combined with the injection of posteromedialis branch of spinal nerves and accupotomy ; （ 2 ） patients suffering from neural roots pain symptoms were treated by intraforaminal injection and extra foraminal injection, with accupotomy to relax the soft tissue around extraforaminality; （ 3 ） patients suffering from lumbesacral stiff were treated by injection into ligament interspinate, posteromedialis branches of spinal nerves and processus transverses of lumbar vertebra, plus accupotomy; （4）patients suffering from numbness treated by mecobalamin VitB. Results The curative effects were no statistically significant differences between different types of remaining symptoms,and also between different periods after 3,6,12 months（ P 〉 0. 05 ）. Conclusion There is a high rate of postoperative remaining symptoms after colllagenase chemonucleolysis in intervertibral disc. The curative effects of different treatment types are similar. The effects are stable for 3 months.
出处
《实用疼痛学杂志》
2006年第2期70-74,共5页
Pain Clinic Journal
关键词
胶原酶
化学松解术
椎间盘
术后残留症状
分析
处理
Collagenase
Chemonueleolysis
Intervertebral disk
Postoperation remaining symptoms
Analysis
Treatment
