激光联合胶原酶治疗腰椎间盘突出症的回顾性分析

发布时间：2018-03-13 14:03

本文选题：腰椎间盘突出症　切入点：胶原酶　出处：《蚌埠医学院》2015年硕士论文　论文类型：学位论文

【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%(P0.05)。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(P0.05),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(P0.05)。联合组远期VAS评分为2.53±1.28,单纯胶原酶组为3.40±1.61(P0.05)。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。
[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 卤1.28, and that of the simple collagenase group was 3.40 卤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.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R681.53

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