【摘要】：目的:探討經(jīng)頸前外側(cè)入路行頸椎間盤穿刺,根據(jù)造影劑分布調(diào)整針尖位置,靶位注射高濃度低容量膠原酶注射液的方法用于治療巨大型頸椎間盤突出癥的臨床療效及安全性。為臨床治療巨大頸椎間盤突出癥提供新的治療方法。方法:收集CT掃描頸椎間盤突出矢狀徑大于同節(jié)段椎管矢狀徑二分之一的巨大型頸椎間盤突出癥,有典型頸椎間盤突出癥臨床表現(xiàn),且排除頸椎間盤膠原酶化學(xué)溶解術(shù)禁忌癥患者納入研究對象。根據(jù)患者主觀意愿分為兩組,膠原酶+神經(jīng)阻滯治療組(A組)和神經(jīng)阻滯組(B組)。A組30例,采用CT定位下經(jīng)頸前外側(cè)入路穿刺至頸椎間盤內(nèi),注射造影劑0.1ml,根據(jù)造影劑分布調(diào)節(jié)針尖位置滿意后,間斷分次推注入0.2~0.3ml膠原酶溶液(含300u膠原酶)。術(shù)后第二天采用頸椎硬膜外神經(jīng)阻滯治療,取C7-T1為穿刺點(diǎn),行頸椎硬膜外腔穿刺置管術(shù),經(jīng)硬膜外導(dǎo)管分次注入2%利多卡因3ml、地塞米松10mg、維生素B1100mg、維生素B121000μg加生理鹽水共12ml,每周做一次,一共做四次。B組27例,單純行頸椎硬膜外神經(jīng)阻滯治療。記錄兩組患者治療后3天、7天、1月及半年的VAS評分;改良Macnab法評定兩組患者治療后1周、1月、半年的綜合療效;比較A組術(shù)前及術(shù)后1周突出物平均CT值變化;隨訪術(shù)后半年復(fù)查CT計(jì)算突出物指數(shù)變化;觀察兩組患者治療中及治療后不良反應(yīng)發(fā)生情況。結(jié)果:1、兩組患者的年齡、性別及病程比較無顯著性差異(P0.05);2、VAS評分:組內(nèi)比較:A組:術(shù)后3天VAS評分較術(shù)前顯著降低(P0.05);術(shù)后1周、1月及6月的VAS評分較術(shù)前顯著減低(P0.01),B組治療后3天、1周及1月的VAS評分較治療前顯著降低(P0.01);治療后半年VAS評分為與術(shù)前顯著降低(P0.05)。組間比較:術(shù)后3天及1周兩組VAS評分比較,無統(tǒng)計(jì)學(xué)意義(P0.05),A、B兩組疼痛緩解程度一致;術(shù)后1月兩組比較,有統(tǒng)計(jì)學(xué)意義(P0.05),A組疼痛緩解較B組明顯;術(shù)后半年兩組VAS比較,有統(tǒng)計(jì)學(xué)意義(P0.01),A組疼痛緩解程度明顯優(yōu)于B組。3、術(shù)后Macnab改良法評定療效:術(shù)后1周、術(shù)后1月比較A、B兩組有效率,無統(tǒng)計(jì)學(xué)意義(P0.05)。術(shù)后半年比較A、B兩組有效率,差異有統(tǒng)計(jì)學(xué)意義(P0.01),A組較B組明顯有效。術(shù)后1周比較A、B兩組優(yōu)良率,B組優(yōu)良率優(yōu)于A組,有統(tǒng)計(jì)學(xué)意義(P0.01);術(shù)后1月比較A、B兩組優(yōu)良率,無統(tǒng)計(jì)學(xué)意義(P0.05);術(shù)后半年比較A、B兩組優(yōu)良率,A組優(yōu)良率優(yōu)于B組,有統(tǒng)計(jì)學(xué)意義(P0.01)。4、A組術(shù)后影像學(xué)改變:術(shù)后半年,有18例患者復(fù)查頸椎CT,突出縮小優(yōu)良率為94.4%。5、不良反應(yīng):A、B兩組均無誤入蛛網(wǎng)膜下腔及脊髓損傷病例,遠(yuǎn)期隨訪也無嚴(yán)重并發(fā)癥及死亡病例。結(jié)論:1、在CT定位下,經(jīng)頸前外側(cè)入路穿刺進(jìn)入椎間盤內(nèi),通過造影劑分布調(diào)整針尖至最佳位置,靶位注入少容量高濃度膠原酶的方法學(xué)用于治療巨大頸椎間盤突出癥是可行的。2、VAS評分及改良Macnab評估綜合療效結(jié)果顯示:盤內(nèi)注射膠原酶聯(lián)合神經(jīng)阻滯治療方法用于治療巨大頸椎間盤突出癥中遠(yuǎn)期療效優(yōu)于單純神經(jīng)阻滯治療。
[Abstract]:Objective: To investigate the clinical efficacy and safety of high concentration and low volume collagenase injection through anterolateral cervical approach for the treatment of giant cervical disc herniation. Collagenase + nerve block was used to treat giant cervical disc herniation with typical clinical manifestations and excluding the contraindication of cervical disc collagenase chemolysis. The treatment group (group A) and the nerve block group (group B). 30 cases in group A were punctured into the cervical intervertebral disc via anterolateral cervical approach under CT guidance. Contrast agent 0.1ml was injected into the cervical intervertebral disc and 0.2-0.3ml collagenase solution (including 300u collagenase) was injected intermittently and steadily according to the distribution of contrast agent. C7-T1 was taken as the puncture point for cervical spinal epidural puncture and catheterization. 2% lidocaine 3 ml, dexamethasone 10 mg, vitamin B1100 mg, vitamin B121000 mg plus normal saline 12 ml were injected through epidural catheter. 27 patients in group B were treated with cervical spinal epidural nerve block only. The VAS scores of day, 7 days, 1 month and 6 months after treatment were evaluated by modified Macnab method. The average CT value of protrusions in group A was compared before operation and 1 week after operation. The protrusion index was calculated by follow-up CT half a year after operation. The adverse reactions in two groups were observed. There was no significant difference in age, sex and course of disease (P 0.05); 2, VAS score: In group A, VAS score was significantly lower at 3 days after operation than that before operation (P 0.05); VAS score at 1 week, 1 month and 6 months after operation was significantly lower than that before operation (P 0.01); VAS score at 3 days, 1 week and 1 month after treatment in group B was significantly lower than that before treatment (P 0.01). There was no significant difference in VAS score between the two groups at 3 days and 1 week after operation (P Compared with group B, the effective rate of group A and B was statistically significant (P There was no significant difference in the excellent and good rate between group A and group B (P 0.05) at 1 month after operation. The excellent and good rate of group A was better than that of group B (P 0.01). There were no serious complications and deaths in the long-term follow-up. Conclusion: 1. It is feasible to treat giant cervical intervertebral disc herniation by injecting low volume and high concentration collagenase into the target position and adjusting the needle tip to the best position through the anterolateral cervical approach under CT guidance. VAS score and modified Macnab evaluation showed that intradiscal injection of collagenase combined with nerve block was superior to nerve block in the treatment of giant cervical disc herniation.
【學(xué)位授予單位】：四川醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R614

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本文編號：2241510