本文選題：射頻熱凝　切入點(diǎn)：豬腰椎間盤(pán)　出處：《廣州醫(yī)科大學(xué)》2014年碩士論文　論文類(lèi)型：學(xué)位論文

【摘要】：第一部分不同射頻熱凝溫度對(duì)離體豬腰椎間盤(pán)的病理學(xué)影響 研究目的 探討射頻熱凝溫度對(duì)離體豬腰椎間盤(pán)組織大體及病理學(xué)變化，為臨床射頻熱凝溫度模式提供參考。 材料與方法 離體正常新鮮豬腰椎間盤(pán)42個(gè)（包括兩個(gè)椎體一個(gè)椎間盤(pán)），分為空白對(duì)照組、60℃60S射頻熱凝組、70℃60S射頻熱凝組、80℃60S射頻熱凝組、90℃60S射頻熱凝組、95℃60S射頻熱凝組、模擬臨床射頻熱凝組（60℃、70℃、80℃、90℃各60S，95℃120S），每組6個(gè)標(biāo)本，經(jīng)消融處理后，取組織做HE染色、Masson三色法染色（特染膠原纖維）、糖原ABPAS染色（特染酸性蛋白多糖），光學(xué)顯微鏡下觀察其組織病理變化。 結(jié)果 1、腰椎間盤(pán)經(jīng)射頻熱凝后隨溫度增高組織皺縮、凝固越明顯，變性組織顏色逐漸加深，消融范圍呈增大趨勢(shì)，達(dá)到一定溫度后不再改變，模擬臨床射頻組變化最明顯。 2、HE染色：正常纖維環(huán)膠原纖維排列規(guī)則有序，呈交叉網(wǎng)狀樣結(jié)構(gòu)，髓核為大量粘液組織，無(wú)特殊排列結(jié)構(gòu)；射頻熱凝后纖維環(huán)膠原纖維排列方向發(fā)生改變，交錯(cuò)、紊亂，髓核組織染色未見(jiàn)明顯變化。 3、Masson三色法：正常纖維環(huán)膠原纖維被染成藍(lán)色，排列規(guī)則有序，髓核組織少量淡藍(lán)色，無(wú)規(guī)則排列；實(shí)驗(yàn)組中溫度從60℃-90℃射頻熱凝后纖維環(huán)組織藍(lán)色逐漸變淡，藍(lán)色比例降低，密度變小，膠原纖維含量逐漸減少，90°、95°、臨床模擬組之間差別不大，實(shí)驗(yàn)組間髓核的顏色無(wú)明顯區(qū)別，都比對(duì)照組的顏色更淡。 4、糖原ABPAS染色：對(duì)照組纖維環(huán)膠原蛋白排列規(guī)則有序，少量淡藍(lán)色，髓核組織被染成藍(lán)色，顏色深，密度大，無(wú)規(guī)則排列；實(shí)驗(yàn)組各組纖維環(huán)組織經(jīng)射頻熱凝后膠原蛋白排列發(fā)生改變，交錯(cuò)、紊亂，髓核組織從60℃-90℃藍(lán)色逐漸變淡，密度變小，，90℃、95℃、臨床模擬組只可見(jiàn)少量藍(lán)色，區(qū)分不明顯，髓核組織經(jīng)射頻熱凝后酸性蛋白多糖在60℃-90℃逐漸減少趨勢(shì)，90℃后變化不明顯。 結(jié)論 1、大于60℃的射頻熱凝溫度使椎間盤(pán)組織發(fā)生凝固、變性，破壞膠原纖維排列方向，交錯(cuò)、紊亂，使膠原纖維變性減少，酸性蛋白多糖減少。 2、在一定射頻熱凝溫度內(nèi)（60-90℃），纖維環(huán)膠原纖維量隨溫度增高而減少，大于90℃后變化不再明顯，髓核酸性糖蛋白含量隨溫度增高而減少，大于90℃后變化不再明顯。 3、逐步提高射頻熱凝溫度，有利于增大消融范圍，90℃與95℃射頻熱凝后腰椎間盤(pán)組織的大體改變區(qū)分不明顯。 第二部分射頻熱凝治療腰椎間盤(pán)突出癥的臨床療效分析 目的 觀察射頻熱凝治療腰椎間盤(pán)突出癥的臨床療效。 方法 本研究選擇2012年9月至2013年9月在廣州醫(yī)學(xué)院荔灣醫(yī)院骨科C型臂下射頻熱凝治療腰椎間盤(pán)突出癥60例，L4/L5椎間盤(pán)突出41例，L5/Sl椎問(wèn)盤(pán)突出19例，均有不同程度的腰背痛及下肢疼痛、麻木，所有病例都剛經(jīng)CT或MR檢查確診，患者均經(jīng)過(guò)中西醫(yī)多種保守方法治療，且經(jīng)治療無(wú)效或療效不佳或治療好轉(zhuǎn)后反復(fù)發(fā)作。用1％利多卡因局部浸潤(rùn)麻醉后，在C型臂透視下用20G射頻穿刺針經(jīng)安全三角入路穿刺進(jìn)入椎間盤(pán)后緣，穿刺滿(mǎn)意后行阻抗測(cè)試、電生理測(cè)試后，給予60℃、70℃、80℃、90℃各60秒，95℃120秒，對(duì)病變椎間盤(pán)進(jìn)行熱凝消融。住院期間，觀察VAS評(píng)分及直腿抬高變化；出院后隨訪(fǎng)6個(gè)月，采用改良的MacNab法來(lái)評(píng)定療效。 結(jié)果 出院時(shí)，VAS評(píng)分由術(shù)前（6.8±1.3）分下降到（1.2±0.8）分，直腿抬高試驗(yàn)由術(shù)前（38±11）°提高到（69±10）°；隨訪(fǎng)6個(gè)月，按改良MacNab法評(píng)價(jià)，優(yōu)良率由術(shù)后一月的61.7％提高至85.0％，均無(wú)嚴(yán)重并發(fā)癥發(fā)生。 結(jié)論 射頻熱凝治療腰椎問(wèn)盤(pán)突出癥具有創(chuàng)傷小、安全性高、恢復(fù)快、療效確切等優(yōu)點(diǎn)，是治療腰椎間盤(pán)突出癥安全有效的方法。
[Abstract]:The pathological effects of different radiofrequency thermocoagulation temperature on the lumbar intervertebral disc of pigs in vitro
research objective
To explore the general and pathological changes of the radiofrequency thermocoagulation temperature on the lumbar intervertebral disc in vitro, and to provide a reference for the clinical radiofrequency thermocoagulation temperature model.
Materials and methods
Isolated normal fresh pig lumbar disc 42 (including a two vertebral disc), divided into blank control group, 60 C 60S radiofrequency group, 60S 70 degrees of radiofrequency thermocoagulation group, 80 C 60S radiofrequency group, 60S 90 degrees of radiofrequency thermocoagulation group, 95 C 60S RF heat coagulation group, simulated clinical radiofrequency group (60 C, 70 C, 80 C, 90 C, 95 C 60S, 120S), 6 specimens in each group, after ablation treatment, tissue HE staining, Masson trichrome staining (staining collagen fibers), glycogen staining (ABPAS staining of acidic protein polysaccharide), observed by optical microscope and its tissue pathological changes.
Result
1, after radiofrequency thermocoagulation, the tissue of the lumbar intervertebral disc shrinks with the increase of temperature. The more obvious the coagulation is, the more the color of the degeneration tissue deepens. The ablation range is increasing. When the temperature reaches a certain temperature, it will no longer change. The simulated clinical radiofrequency group is the most obvious.
2, HE staining: the normal fibrous ring collagen fibers arranged regularly and orderly, showing a cross mesh like structure. The nucleus pulposus is a large number of mucus tissues, and there is no special arrangement structure. After radiofrequency thermocoagulation, the direction of collagen fiber alignment changes, interlace and disorder, and there is no obvious change in the staining of nucleus pulposus.
3 Masson staining: normal fiber ring collagen fibers were dyed blue, ordered, a small amount of nucleus pulposus pale blue, irregular arrangement; the temperature in the experimental group from 60 DEG -90 DEG after radiofrequency thermocoagulation of fibrous ring blue gradually fades, blue ratio decreased, density decreases, collagen fiber content decreased gradually, 90 degrees, 95 degrees, there is little difference between clinical simulation group, no significant difference between the experimental groups nucleus color, compared with the control group the color is more pale.
4, ABPAS glycogen staining: control group ordered collagen fiber ring, a light blue nucleus pulposus tissue were stained blue, deep color, high density, irregular arrangement; the experimental group were fiber ring after radiofrequency thermocoagulation after collagen arrangement changed, staggered, disorder, nucleus pulposus tissue from 60 DEG -90 DEG blue gradually fades, the density becomes smaller, 90 C, 95 C, only a small amount of blue visible clinical simulation group, distinction is not obvious, the nucleus pulposus of radiofrequency thermocoagulation after acid proteoglycan at 60 DEG -90 DEG gradually decreased, no significant change after 90 degrees.
conclusion
1, the radiofrequency temperature greater than 60 degrees makes the intervertebral disc tissue solidified and denatured, disrupting the alignment direction of collagen fibers, staggered and disordered, resulting in degeneration of collagen fibers and decrease of acidic proteoglycan.
2, within a certain RF curing temperature (60-90 C), the amount of collagen fiber decreased with increasing temperature. When the temperature was greater than 90 degrees, the change of collagen fiber content was no longer obvious, and the content of myelin nucleic acid glycoprotein decreased with the increase of temperature, and the change was not obvious after more than 90 degrees centigrade.
3, increasing the temperature of radiofrequency thermocoagulation is beneficial to increase the ablation range. The differentiation of the lumber intervertebral disc after radiofrequency thermocoagulation at 90 and 95 C is not obvious.
Analysis of the clinical effect of second parts of radiofrequency thermocoagulation in the treatment of lumbar disc herniation
objective
To observe the clinical effect of radiofrequency thermocoagulation in the treatment of protrusion of lumbar intervertebral disc.
Method
This study from September 2012 to September 2013 in the Department of orthopedics, Liwan Hospital of Guangzhou Medical College, C type arm radiofrequency thermocoagulation for the treatment of lumbar disc herniation in 60 cases, L4/L5 41 cases of lumbar disc herniation, L5/Sl intervertebral disc herniation in 19 cases, low back pain and leg pain and numbness in varying degrees, all cases are just by CT or MR examination. The patients were diagnosed by a variety of Chinese and Western medicine conservative treatment, and the treatment is invalid or poor efficacy or improved treatment after repeated attacks. With 1% lidocaine local infiltration anesthesia, under the C arm perspective 20G RF needle through triangle approach puncture into intervertebral disc puncture was performed with the trailing edge, impedance test, electric physiological tests, 60 C, 70 C, 80 C, 90 C, 95 C and 60 seconds, 120 seconds, the pathological disc by thermal coagulation ablation. During hospitalization, observe the VAS scores and straight leg raising change; followed up 6 months after discharge, using improved Ma The cNab method was used to evaluate the curative effect.
Result
At discharge, VAS score decreased from preoperative (6.8 + 1.3) to (1.2 + 0.8). Straight leg raising test increased from preoperative (38 + 11) degrees to (69 + 10) degrees. During follow-up for 6 months, according to the modified MacNab method, the excellent and good rate increased from 61.7% to 85% in one month after operation, and no serious complication occurred.
conclusion
Radiofrequency thermocoagulation for lumbar disc herniation is a safe and effective method for the treatment of lumbar disc herniation, with the advantages of small trauma, high safety, quick recovery and definite curative effect.

【學(xué)位授予單位】：廣州醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R681.5

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