摘要
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.
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.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2010年第5期508-512,共5页
Chinese Journal of Radiology
关键词
椎间盘移位
臭氧
磁共振成像
放射学
介入性
Intervertebral disk displacement
Ozone
Magnetic resonance imaging
Radiology, interventional
