摘要
目的评价激光联合胶原酶治疗腰椎间盘突出症的临床疗效,探讨其适应症,分析疗效不佳的原因。方法回顾性分析2005年6月—2007年7月期间在蚌埠医学院第一附属医院行经皮激光椎间盘减压术联合胶原酶溶解术和单纯胶原酶溶解术治疗的腰椎间盘突出症病例资料,2组各30例。根据视觉模拟评分(VAS)和改良Mac Nab方法评价其疗效,计数资料采用秩和检验,计量资料采用t检验。比较2组近、远期疗效,分析联合组疗效不佳的原因。结果 2组患者性别、年龄、病程、突出间隙、突出类型差异无统计学意义。近期疗效优良率联合组为93.3%,单纯胶原酶组为80.0%,差异有统计学意义(P<0.05)。远期疗效优良率联合组为86.7%,单纯胶原酶组为66.7%,差异有统计学意义(P<0.05)。联合组近、远期疗效对比差异无统计学意义(P>0.05)。联合组远期VAS评分为2.53±1.28,单纯胶原酶组为3.40±1.61,差异有统计学意义(P<0.05)。联合组无一例复发,单纯胶原酶组有2例复发。联合组中4例疗效欠佳,胶原酶组中8例疗效欠佳。结论联合使用激光汽化减压术和胶原酶两种技术,比单纯胶原酶溶解术可显著提高优良率和降低复发率,扩大了适应证,对盘内压高、突出较大的椎间盘突出症远期疗效确切、稳定,是一种安全、有效治疗腰椎间盘突出症的方法,值得临床推广。
Objective To evaluate the curative effects of percutaneous laser disc decompression （PLDD） combined with collagenase injection in the treatment of lumbar disc, and discuss the indications and the cause of poor curative effect. Methods We carried out a retrospective study of patients who underwent PLDD combined with collagenase injec- tion and pure collagenase injection from June 2005--July 2007 in our hospital. There were 30 cases in both groups. The curative effects were evaluated by visual analog scale （VAS） and modified MacNab, count date using rank-sum test, t test were utilized to compare measurement date. The short term and long term curative effect were compared between the two groups, and analyze the cause of imperfect outcomes in some cases. Results There was no statistical difference with re- spect to gender, age, duration, level of disc herniation, type of disc herniation of two groups. The recent curative effect of the combined group was 93. 3%, of the pure collagenase group was 80%, it had statistically significant （P 〈 O. 05 ）. The long-term curative effect of combined group was 86. 7%, of the pure collagenase group was 66. 7%, the difference was sig- nificant（P 〈 0. 05）. There was no statistical difference between short term curative effect and long term curative effect in the combined group（P 〉0. 05）. The long term VAS score of combined group was 2. 53 ± 1.28 ,of the pure collagenase group was 3.40 ±1.61, there was significant difference （ P 〈 0.05 ）. No recurrence in the combined group, but 2 in the pure collagenase group. 4 cases in the combined group and 8 cases in the control group were with imperfect outcomes. Conclusion The combination of PLDD and collagenase injection can improve the long term excellent rate for LDH patients,it is a safe and effect method for LDH. It is worth to extend to clinic application.
出处
《中华全科医学》
2015年第9期1417-1419,1483,共4页
Chinese Journal of General Practice
关键词
腰椎间盘突出症
胶原酶
激光
Percutaneous laser disc decompression
Collagenase
Laser therapy
