射频热凝治疗腰椎间盘突出症的实验与临床研究

发布时间：2018-03-15 06:36

本文选题：射频热凝　切入点：猪腰椎间盘　出处：《广州医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：第一部分不同射频热凝温度对离体猪腰椎间盘的病理学影响研究目的探讨射频热凝温度对离体猪腰椎间盘组织大体及病理学变化，为临床射频热凝温度模式提供参考。材料与方法离体正常新鲜猪腰椎间盘42个（包括两个椎体一个椎间盘），分为空白对照组、60℃60S射频热凝组、70℃60S射频热凝组、80℃60S射频热凝组、90℃60S射频热凝组、95℃60S射频热凝组、模拟临床射频热凝组（60℃、70℃、80℃、90℃各60S，95℃120S），每组6个标本，经消融处理后，取组织做HE染色、Masson三色法染色（特染胶原纤维）、糖原ABPAS染色（特染酸性蛋白多糖），光学显微镜下观察其组织病理变化。结果 1、腰椎间盘经射频热凝后随温度增高组织皱缩、凝固越明显，变性组织颜色逐渐加深，消融范围呈增大趋势，达到一定温度后不再改变，模拟临床射频组变化最明显。 2、HE染色：正常纤维环胶原纤维排列规则有序，呈交叉网状样结构，髓核为大量粘液组织，无特殊排列结构；射频热凝后纤维环胶原纤维排列方向发生改变，交错、紊乱，髓核组织染色未见明显变化。 3、Masson三色法：正常纤维环胶原纤维被染成蓝色，排列规则有序，髓核组织少量淡蓝色，无规则排列；实验组中温度从60℃-90℃射频热凝后纤维环组织蓝色逐渐变淡，蓝色比例降低，密度变小，胶原纤维含量逐渐减少，90°、95°、临床模拟组之间差别不大，实验组间髓核的颜色无明显区别，都比对照组的颜色更淡。 4、糖原ABPAS染色：对照组纤维环胶原蛋白排列规则有序，少量淡蓝色，髓核组织被染成蓝色，颜色深，密度大，无规则排列；实验组各组纤维环组织经射频热凝后胶原蛋白排列发生改变，交错、紊乱，髓核组织从60℃-90℃蓝色逐渐变淡，密度变小，，90℃、95℃、临床模拟组只可见少量蓝色，区分不明显，髓核组织经射频热凝后酸性蛋白多糖在60℃-90℃逐渐减少趋势，90℃后变化不明显。结论 1、大于60℃的射频热凝温度使椎间盘组织发生凝固、变性，破坏胶原纤维排列方向，交错、紊乱，使胶原纤维变性减少，酸性蛋白多糖减少。 2、在一定射频热凝温度内（60-90℃），纤维环胶原纤维量随温度增高而减少，大于90℃后变化不再明显，髓核酸性糖蛋白含量随温度增高而减少，大于90℃后变化不再明显。 3、逐步提高射频热凝温度，有利于增大消融范围，90℃与95℃射频热凝后腰椎间盘组织的大体改变区分不明显。第二部分射频热凝治疗腰椎间盘突出症的临床疗效分析目的观察射频热凝治疗腰椎间盘突出症的临床疗效。方法本研究选择2012年9月至2013年9月在广州医学院荔湾医院骨科C型臂下射频热凝治疗腰椎间盘突出症60例，L4/L5椎间盘突出41例，L5/Sl椎问盘突出19例，均有不同程度的腰背痛及下肢疼痛、麻木，所有病例都刚经CT或MR检查确诊，患者均经过中西医多种保守方法治疗，且经治疗无效或疗效不佳或治疗好转后反复发作。用1％利多卡因局部浸润麻醉后，在C型臂透视下用20G射频穿刺针经安全三角入路穿刺进入椎间盘后缘，穿刺满意后行阻抗测试、电生理测试后，给予60℃、70℃、80℃、90℃各60秒，95℃120秒，对病变椎间盘进行热凝消融。住院期间，观察VAS评分及直腿抬高变化；出院后随访6个月，采用改良的MacNab法来评定疗效。结果出院时，VAS评分由术前（6.8±1.3）分下降到（1.2±0.8）分，直腿抬高试验由术前（38±11）°提高到（69±10）°；随访6个月，按改良MacNab法评价，优良率由术后一月的61.7％提高至85.0％，均无严重并发症发生。结论射频热凝治疗腰椎问盘突出症具有创伤小、安全性高、恢复快、疗效确切等优点，是治疗腰椎间盘突出症安全有效的方法。
[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.

【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R681.5

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