【作者】 张进；

【导师】 梁启胜； 林学武；

【作者基本信息】 蚌埠医学院 ， 临床医学（专业学位）， 2015， 硕士

【摘要】 目的:腰椎间盘突出症(lumbar disc herniation,LDH)是一种常见、多发的疼痛科疾病,常引起强烈腰部疼痛,并发的坐骨神经痛及其他神经功能障碍等症状,使患者生活受到影响,重者还会导致脊柱畸形,进一步丧失劳动能力。本文主要探讨一种有效、安全、微创的治疗方法,研究了激光联合胶原酶治疗腰椎间盘突出症的临床疗效及适应症,分析疗效不佳的原因,以指导临床工作。方法:回顾性分析2005年6月-2007年7月期间在我医院行经皮激光椎间盘减压术(percutaneous laser disc decompression,PLDD)联合胶原酶溶解术(collagenase chemonucleolysis,CCNL)和单纯胶原酶溶解术治疗的腰椎间盘突出症病例资料,两组各30例。采用视觉模拟评分(VAS)、改良Mac Nab评分评价其疗效,计数资料用秩和检验,计量资料用t检验。比较两组近、远期疗效,分析联合组疗效不佳的原因。结果:两组患者性别、年龄、病程、突出间隙、突出类型无统计学差异。近期疗效联合组为93.3%,单纯胶原酶组为80%(P<0.05)。近期疗效方面,联合组优于单纯胶原酶组。远期疗效联合组为86.7%,单纯胶原酶组为66.7%。两者远期疗效有显著性差异(P<0.05),联合组优于单纯胶原酶组。联合组近期、远期疗效对比无统计学差异(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(P<0.05)。联合组无一例复发,单纯胶原酶组有两例复发。联合组中4例疗效欠佳,而胶原酶组中8例疗效欠佳。结论:联合使用经皮激光椎间盘减压术和胶原酶溶解术,与单纯使用胶原酶溶解术相比,可显著提高优良率和降低复发率,扩大了适应症,对盘内压高、突出较大的椎间盘突出症远期疗效较佳,可能是治疗腰椎间盘突出症的一种安全、有效方法,值得临床推广。更多还原

【Abstract】 Object: Lumbar disc herniation(LDH) is the most common disease, caused low back pain,sciatic and other function destruction. LDH cause inconvenience to people’s daily life. To evaluate the curative effects of percutaneous laser disc decompression combined with collagenase injection in the treatment of lumbar disc, discuss the indications, analyze the cause of poor curative effect.Method: We carried out a retrospective study of patients who underwent PLDD combined with collagenase injection and underwent pure collagenase injection from June 2005-July 2007 in our hospital. Two groups both have 30 cases. The curative effects were evaluated based on visual analog scale(VAS) and modified Mac Nab,count date using rank-sum test, t test were utilized to compare measurement date.Compare two groups of short term and long term curative effect, analyze the cause of poor combined treatment group.Result: There was no statistical difference with respect to gender, age, duration, level of disc herniation, type of disc herniation of two groups. Recent curative effect of combined group was 93.3%, the pure collagenase group was 80%, statistically significant(P<0.05). The long-term curative effect of combined group was 86.7%,66.7% pure collagenase group. The long-term effect have significant difference(P<0.05). Combined group short, long term curative effect compared with no statistical difference(P>0.05). long term VAS score of combined group was2.53±1.28, pure collagenase group was 3.40±1.61, there is significant difference(P<0.05). No recurrence in combined group, pure collagenase group has two cases of recurrence. 4 cases in a combined group curative effect is poor and 8 cases with collagenase have poor curative effect.Conclusion: The combination of PLDD and collagenase injection can improve long term excellent rate for LDH patients, so it is a safe and effect method to treat LDH. It is worth to extend to clinic application.更多还原