發(fā)布時(shí)間：2018-03-13 14:03

  本文選題：腰椎間盤突出癥　切入點(diǎn)：膠原酶　出處：《蚌埠醫(yī)學(xué)院》2015年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:腰椎間盤突出癥(lumbar disc herniation,LDH)是一種常見、多發(fā)的疼痛科疾病,常引起強(qiáng)烈腰部疼痛,并發(fā)的坐骨神經(jīng)痛及其他神經(jīng)功能障礙等癥狀,使患者生活受到影響,重者還會(huì)導(dǎo)致脊柱畸形,進(jìn)一步喪失勞動(dòng)能力。本文主要探討一種有效、安全、微創(chuàng)的治療方法,研究了激光聯(lián)合膠原酶治療腰椎間盤突出癥的臨床療效及適應(yīng)癥,分析療效不佳的原因,以指導(dǎo)臨床工作。方法:回顧性分析2005年6月-2007年7月期間在我醫(yī)院行經(jīng)皮激光椎間盤減壓術(shù)(percutaneous laser disc decompression,PLDD)聯(lián)合膠原酶溶解術(shù)(collagenase chemonucleolysis,CCNL)和單純膠原酶溶解術(shù)治療的腰椎間盤突出癥病例資料,兩組各30例。采用視覺模擬評(píng)分(VAS)、改良Mac Nab評(píng)分評(píng)價(jià)其療效,計(jì)數(shù)資料用秩和檢驗(yàn),計(jì)量資料用t檢驗(yàn)。比較兩組近、遠(yuǎn)期療效,分析聯(lián)合組療效不佳的原因。結(jié)果:兩組患者性別、年齡、病程、突出間隙、突出類型無統(tǒng)計(jì)學(xué)差異。近期療效聯(lián)合組為93.3%,單純膠原酶組為80%(P0.05)。近期療效方面,聯(lián)合組優(yōu)于單純膠原酶組。遠(yuǎn)期療效聯(lián)合組為86.7%,單純膠原酶組為66.7%。兩者遠(yuǎn)期療效有顯著性差異(P0.05),聯(lián)合組優(yōu)于單純膠原酶組。聯(lián)合組近期、遠(yuǎn)期療效對(duì)比無統(tǒng)計(jì)學(xué)差異(P0.05)。聯(lián)合組遠(yuǎn)期VAS評(píng)分為2.53±1.28,單純膠原酶組為3.40±1.61(P0.05)。聯(lián)合組無一例復(fù)發(fā),單純膠原酶組有兩例復(fù)發(fā)。聯(lián)合組中4例療效欠佳,而膠原酶組中8例療效欠佳。結(jié)論:聯(lián)合使用經(jīng)皮激光椎間盤減壓術(shù)和膠原酶溶解術(shù),與單純使用膠原酶溶解術(shù)相比,可顯著提高優(yōu)良率和降低復(fù)發(fā)率,擴(kuò)大了適應(yīng)癥,對(duì)盤內(nèi)壓高、突出較大的椎間盤突出癥遠(yuǎn)期療效較佳,可能是治療腰椎間盤突出癥的一種安全、有效方法,值得臨床推廣。
[Abstract]:Objective: lumbar disc herniation (LDHs) is a common and multiple pain disease, which often causes severe lumbar pain, complicated sciatica and other neurological disorders, which affects the life of the patients. In this paper, an effective, safe and minimally invasive treatment method was discussed, and the clinical efficacy and indications of laser combined with collagenase in the treatment of lumbar disc herniation were studied. To analyze the causes of the poor curative effect, Methods: to guide clinical work. Methods: a retrospective analysis of the lumbar intervertebral interbody treated by percutaneous laser disc decompression combined with collagenase lysis and collagenase lysis was performed in our hospital from June 2005 to July 2007. Case data of disc herniation, Visual analogue score (VAS), modified Mac Nab score (Mac Nab) were used to evaluate the curative effect, rank sum test was used to count the data, and t test was used to measure the data. Results: there was no significant difference in sex, age, course of disease, protruding gap and type of protrusion between the two groups. The short-term curative effect was 93.3 in the combined group and 80 in the collagenase group. The combined group was superior to the collagenase group. The long-term curative effect was 86.7 in the combined group and 66.7 in the simple collagenase group. There was a significant difference between the two groups (P 0.05), and the combined group was superior to the collagenase group in the near future. There was no significant difference in long-term curative effect between the two groups. The long-term VAS score of the combined group was 2.53 鹵1.28, and that of the simple collagenase group was 3.40 鹵1.61p0.050.There was no recurrence in the combined group, two in the collagenase group, 4 cases in the combined group, and 4 cases in the combined group. Conclusion: the combined use of percutaneous laser disc decompression and collagenase lysis can significantly increase the excellent and good rate and reduce the recurrence rate, and expand the indication, compared with the simple use of collagenase lysis. It may be a safe and effective method for the treatment of lumbar disc herniation, which is worth popularizing.
【學(xué)位授予單位】：蚌埠醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R681.53

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本文編號(hào)：1606692