骶裂孔前间隙法胶原酶溶解术治疗腰椎间盘突出症远期随访

A ONE TO THREE YEAR FOLLOW-UP REVIEW OF TREATMENT OF LUMBAR DISC HERNIATION USING CHEMONUCLEOLYSIS WITH EXTRA DISC INJECTION OF COLLAGENASE FROM THE ANTERIOR EPIDURAL SPACE VIA HIATUS SACRALIS

摘要:

目的：对骶裂孔前间隙法胶原酶溶解术治疗腰椎间盘突出症360例患者行1-3年随访，以期评价远期治疗效果。方法：术后1年、2年、3年各随访患者120例，全部患者均来院通过询问、体查进行疗效评估。疗效评定标准根据患者术后直腿抬高度、脊椎活动度、VAS评分、患肢肌力、感觉的改变综合评定。然后将各随访年度的患者术前后相关指标进行统计学处理。最后得出术后疗效评估结果，分别以治愈率、优良率、总有效率来表示。结果：各组治疗后VAS评分均明显降低，三组平均值从6．92分降低到0．99分。三组间治疗前、后VAS评分比较无差异。各组间直腿抬高度、脊椎活动度改善的治愈率、优良率、有效率均无差异。各组治愈率、优良率分别是一年组72．5％、87．5％，二年组75．0％、88．3％，三年组79．2％、90．0％。三组间治愈率、优良率比较无差异。但从百分率看出三年中疗效有逐渐增强的趋势。结论：骶裂孔前间隙法胶原酶溶解术治疗腰椎间盘突出症远期疗效满意，尤以三年随访结果更佳，治愈率达到79．2％，优良率达90％、总有效率为95％。

Abstract:

Aim: To assess the effect of treatment of lumbar disc herniation using chemonucleolysis, a one to three years follow-up review was conducted. Method: 360 cases were divided into three groups (1 year, 2 years, 3 years group), each group involving 120 cases. The curative effects of all patients were evaluated by inquiry and physical examination. According to the change of straight leg-raising grade, spine moving grade, sensation, muscle strength and VAS pain scoring, a standard of curative effect gauged were established. The curative effect was expressed as cure and excellent rate. Result: The postoperative VAS score was significantly lower than preoperative level in three groups, the average of VAS score was decreased from 6.92 to 0.99. The cure and excellent rate of 1 to 3 years groups were 72.5%, 87.5%; 75.0%, 88.3% and 79.2%, 90.0% respectively. There is a tendency of increase in success rate along with time. Conclusion: The extra-disc injection of collagenase from anterior epidural space via hiatus sacralis is an effective method for the treatment of lumbar disc herniation.