CT引导下靶位注射胶原酶用于巨大颈椎间盘突出症临床研究
发布时间：2018-09-13 15:00
【摘要】：目的:探讨经颈前外侧入路行颈椎间盘穿刺,根据造影剂分布调整针尖位置,靶位注射高浓度低容量胶原酶注射液的方法用于治疗巨大型颈椎间盘突出症的临床疗效及安全性。为临床治疗巨大颈椎间盘突出症提供新的治疗方法。方法:收集CT扫描颈椎间盘突出矢状径大于同节段椎管矢状径二分之一的巨大型颈椎间盘突出症,有典型颈椎间盘突出症临床表现,且排除颈椎间盘胶原酶化学溶解术禁忌症患者纳入研究对象。根据患者主观意愿分为两组,胶原酶+神经阻滞治疗组(A组)和神经阻滞组(B组)。A组30例,采用CT定位下经颈前外侧入路穿刺至颈椎间盘内,注射造影剂0.1ml,根据造影剂分布调节针尖位置满意后,间断分次推注入0.2~0.3ml胶原酶溶液(含300u胶原酶)。术后第二天采用颈椎硬膜外神经阻滞治疗,取C7-T1为穿刺点,行颈椎硬膜外腔穿刺置管术,经硬膜外导管分次注入2%利多卡因3ml、地塞米松10mg、维生素B1100mg、维生素B121000μg加生理盐水共12ml,每周做一次,一共做四次。B组27例,单纯行颈椎硬膜外神经阻滞治疗。记录两组患者治疗后3天、7天、1月及半年的VAS评分;改良Macnab法评定两组患者治疗后1周、1月、半年的综合疗效;比较A组术前及术后1周突出物平均CT值变化;随访术后半年复查CT计算突出物指数变化;观察两组患者治疗中及治疗后不良反应发生情况。结果:1、两组患者的年龄、性别及病程比较无显著性差异(P0.05);2、VAS评分:组内比较:A组:术后3天VAS评分较术前显著降低(P0.05);术后1周、1月及6月的VAS评分较术前显著减低(P0.01),B组治疗后3天、1周及1月的VAS评分较治疗前显著降低(P0.01);治疗后半年VAS评分为与术前显著降低(P0.05)。组间比较:术后3天及1周两组VAS评分比较,无统计学意义(P0.05),A、B两组疼痛缓解程度一致;术后1月两组比较,有统计学意义(P0.05),A组疼痛缓解较B组明显;术后半年两组VAS比较,有统计学意义(P0.01),A组疼痛缓解程度明显优于B组。3、术后Macnab改良法评定疗效:术后1周、术后1月比较A、B两组有效率,无统计学意义(P0.05)。术后半年比较A、B两组有效率,差异有统计学意义(P0.01),A组较B组明显有效。术后1周比较A、B两组优良率,B组优良率优于A组,有统计学意义(P0.01);术后1月比较A、B两组优良率,无统计学意义(P0.05);术后半年比较A、B两组优良率,A组优良率优于B组,有统计学意义(P0.01)。4、A组术后影像学改变:术后半年,有18例患者复查颈椎CT,突出缩小优良率为94.4%。5、不良反应:A、B两组均无误入蛛网膜下腔及脊髓损伤病例,远期随访也无严重并发症及死亡病例。结论:1、在CT定位下,经颈前外侧入路穿刺进入椎间盘内,通过造影剂分布调整针尖至最佳位置,靶位注入少容量高浓度胶原酶的方法学用于治疗巨大颈椎间盘突出症是可行的。2、VAS评分及改良Macnab评估综合疗效结果显示:盘内注射胶原酶联合神经阻滞治疗方法用于治疗巨大颈椎间盘突出症中远期疗效优于单纯神经阻滞治疗。
[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.
【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614
本文编号：2241510
[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.
【学位授予单位】：四川医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614
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