摘要
目的:由于髂嵴位置高于L5～S1椎间隙,使L5～S1椎间盘突出症的介入治疗有一定的难度,为提高其疗效,探讨介入治疗L5～S1椎间盘突出症的最佳方法。方法:研究对象为1999-08/2003-09新乡医学院第二附属医院放射介入科收治的L5～S1椎间盘突出症患者85例。通过分析及研究其髂嵴与L5～S1椎间隙的关系,对患者采取了不同的介入治疗方法:对穿刺针能够平行进入L5～S1间隙中部时,用经皮腰椎间盘切除术percutaneous(lumbardiscectomy,PLD方法治疗,当穿刺针无法进入L5～S1间隙或进)入较浅时,应用盘外胶原酶化学溶核术,而对大多数的L5～S1椎间盘突出患者,穿刺针斜行进入L5～S1间隙,采用双介入疗法,即PLD+胶原酶化学溶核术。结果:PLD术25例,优19例,良5例,差1例;胶原酶溶解术8例,优4例,良2例,差2例;联合介入疗法52例,优43例,良7例,差2例。均无严重并发症,总有效率为94.12%(80/85),无效率5.88%(5/85)。结论:介入治疗应根据髂嵴与L5～S1椎间隙关系来选择,对于大多数L5～S1椎间盘突出患者,穿刺针及套管只能斜行进入L5～S1间隙,双介入疗法治疗可以改善患者腰背疼痛,恢复感觉和运动障碍。
AIM:The interventional therapy for intervertebral disc herniation(IDH) at L5- S1 level is difficult because iliac crest is higher than L5-S1 intervertebral s pace.In order to increase the therapeutic effect,the optimal method of the diffe rent interventional therapies for L5-S1 IDH was investigated. METHODS:The subjects were 5 patients with L5-S1 IDH who were hospitalized in the Department of Interventional Radiology,Second Affiliated Hospital of Xinxian g Medical College from August 1999 to September 2003.After the relation between the iliac crest and L5-S1 disc space was analyzed and studied,different methods were used for the patietns:Percutaneous lumbar discectomy(PLD) was introduced t o the patients when the puncture needle parallel into the central L5-S1 interve rtebral space;The chemonucleolysis(CNL) was performed when the needle could not puncture into the L5-S1 intervertebral space or too shallow;And the double inte rventional therapy(DIT,PLD+CNL) was managed when the puncture needle was obliqu e into the L5-S1 intervertebral space. RESULTS:PLD,CNL and DIT were performed in 25 cases(excellent in 19 cases,good in 5 and poor in 1),8 cases(excellent in 4 cases,good in 2 and poor in 2) and 52 cases(excellent in 43 cases,good in 7 and poor in 2) respectively,and no seriou s complication was found.The total effective rate was 94.12%(80/85) and ineffec tive rate 5.88%(5/85). CONCLUSION:The method of interventional treatment should be chosen according t o the relation between iliac crest and L5-S1 intervertebral space.If the punctu re needle or trocar is oblique into L5-S1 intervertebral space for most patient s with L5-S1 IDH,the DIT method can relieve their low back pain,recover the sen sory and motor disturbance.
出处
《中国临床康复》
CSCD
北大核心
2005年第2期17-19,共3页
Chinese Journal of Clinical Rehabilitation
基金
河南省教育厅科技攻关项目资助(20013200035)~~
