低温等离子髓核消融术与胶原酶溶解术治疗颈椎间盘突出症的对比研究
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摘要
目的:比较低温等离子髓核消融术(low-temperature plasma nucleoplasty)与胶原酶溶解术(collagenase chemonucleolysis, CNL)治疗颈椎间盘突出症(cervical disc herniation, CDH)的临床疗效。方法:130例颈椎间盘突出症病人随机分为两组(n=65):胶原酶溶解术治疗组(A组)和低温等离子髓核消融术治疗组(B组)。采用视觉模拟评分法(visual analogue scale, VAS)对病人的疼痛水平进行评价,用改良的MacNab标准行手术疗效评估,并分析两组病人术后住院日的差别。结果:两组病人术后1天、1周、1个月、3个月和6个月VAS评分均显著低于术前,差异有统计学意义(P <0.01);但与A组比较,B组术后1天和1周病人VAS评分较术前降低更为显著,差异有统计学意义(P <0.01)。B组术后住院日显著少于A组,差异有统计学意义(P<0.01)。术后6个月A组和B组治疗的优良率分别为86.2%(56/65例)和83.1%(54/65例),两组优良率无统计学差异(P> 0.05)。结论:低温等离子髓核消融术和胶原酶溶解术均能有效治疗颈椎间盘突出症,但术后1周内低温等离子髓核消融术更能有效缓解病人的疼痛。
Objective: To compare the effects of low-temperature plasma nucleoplasty and collagenase chemonucleolysis(CNL) in the treatment of cervical disc herniation(CDH). Methods: One hundred and thirty patients with cervical disc herniation were randomly divided into group A and group B(n = 65 each). Group A and B were treated by CNL and low-temperature plasma nucleoplasty respectively. Visual analogue scale(VAS) was used to evaluate the degree of pain and the modified MacNab criteria was used to evaluate the clinical efficacy. The average length of hospital stay after procedure were analyzed. Results: The VAS scores were significantly decreased(P < 0.01) at 1 st day, 1 week, 1 month, 3 months and 6 months after treatment in both groups compared with pre-treatment. Compared with Goup A, VAS scores remarkably reduced in Group B at 1 st day and 1 week afer treatment(P < 0.01). The average length of hospital stay after treatment of group B were significantly less compared with group A(P < 0.01). There was no significant difference about the excellent and good rate between group A with 86.2%(56/65 cases) and group B with 83.1%(54/65 cases) at 6 month after treatment(P > 0.05). Conclusion: The low-temperature plasma nucleoplasty and CNL are both effective in the treatment of cervical disc herniation. The low-temperature plasma nucleoplasty could be more effective to alleviate the patient' s pain at 1 week after procedure compared with CNL.
Objective: To compare the effects of low-temperature plasma nucleoplasty and collagenase chemonucleolysis(CNL) in the treatment of cervical disc herniation(CDH). Methods: One hundred and thirty patients with cervical disc herniation were randomly divided into group A and group B(n = 65 each). Group A and B were treated by CNL and low-temperature plasma nucleoplasty respectively. Visual analogue scale(VAS) was used to evaluate the degree of pain and the modified MacNab criteria was used to evaluate the clinical efficacy. The average length of hospital stay after procedure were analyzed. Results: The VAS scores were significantly decreased(P < 0.01) at 1 st day, 1 week, 1 month, 3 months and 6 months after treatment in both groups compared with pre-treatment. Compared with Goup A, VAS scores remarkably reduced in Group B at 1 st day and 1 week afer treatment(P < 0.01). The average length of hospital stay after treatment of group B were significantly less compared with group A(P < 0.01). There was no significant difference about the excellent and good rate between group A with 86.2%(56/65 cases) and group B with 83.1%(54/65 cases) at 6 month after treatment(P > 0.05). Conclusion: The low-temperature plasma nucleoplasty and CNL are both effective in the treatment of cervical disc herniation. The low-temperature plasma nucleoplasty could be more effective to alleviate the patient' s pain at 1 week after procedure compared with CNL.
引文
[1]邓毅勇,辛自刚,郭子龙,等.低温等离子髓核成形术复合胶原酶介入治疗颈间盘突出症疗效观察.中国疼痛医学杂志,2014,20(12):927~928.
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[4]何明伟,于密生,孙海燕,等.硬膜外前、侧间隙置管持续注药联合臭氧治疗颈椎间盘突出症的疗效分析.中国康复医学杂志,2012,27(8):741~743.
[5]赵家贵,朱本藩,宋阳,等.CT引导经黄韧带颈后路注射臭氧联合胶原酶治疗颈椎间盘突出症的疗效分析.中国疼痛医学杂志,2015,21(1):43~46.
[6]赵治涛,张增臻,肖珂青,等.CT引导下低温等离子靶点消融治疗颈椎间盘突出症的效果观察.实用放射学杂志,2016,32(7):1106~1108.
[7]王立奎,朱本藩,赵家贵,等.低温等离子射频消融联合O3及消炎镇痛液治疗包容性双节段腰椎间盘突出症的疗效分析.中国疼痛医学杂志,2018,24(6):435~439.
[8]Abrishamkar S,Salimi S,Pirmoradi H.Comparison the postoperation results of discectomy with nucleoplasty in single cervical disc herniation.Advanced Biomedical Research,2018,7(1):29.
[9]Yang CS,Zhang LJ,Sun ZH,et al.Acute prevertebral abscess secondary to intradiscal oxygen-ozone chemonucleolysis for treatment of a cervical disc herniation.JInt Med Res,2018,46(6):2461~2465.
[10]HE JL.Clinical study of CT guided laser ablation combined with collagenase injection and Huoxueshujin prescription in the treatment of lumbar disc herniation.J Minim Invas Med,2016.
[11]Wang ZJ,Zhu MY,Liu XJ,et al.Cervical intervertebral disc herniation treatment via radiofrequency combined with low-dose collagenase injection into the disc interior using an anterior cervical approach.Medicine,2016,95(25):e3953.
[12]张绍杰,侯会文,刘洋,等.经皮旋切术联合胶原酶靶点溶解治疗颈椎间盘突出症.中国疼痛医学杂志,2011,17(3):160~162.
[13]Wu SL,Li X,Lin C,et al.CT-guided nucleoplasty with radiofrequency energy for the treatment of lumbar disc herniation.J Spinal Disord Tech,2015,28(1):9~16.
[14]He L,Yue J,Yang L,et al.Cervicogenic headache alleviation after cervical coblation nucleoplasty:A prospective cohort study.Medicine,2016,95(39):e4786.
[15]怀昌,汪懿,陈永权,等.经皮等离子消融术治疗国人颈椎间盘突出症临床效果的Meta分析.山东医药,2016,56(16):50~52.
[16]Oh HS,Hwang BW,Park SJ,et al.Percutaneous endoscopic cervical discectomy(PECD):an analysis of outcome,causes of reoperation.World Neurosurg,2017,102:583~592.
[2]王文,刘延青,刘建英,等.胶原酶化学溶解术治疗颈椎间盘突出症3700例远期随访.中国疼痛医学杂志,2006,12(5):288~290.
[3]张年春,周跃,初同伟,等.低温等离子消融髓核成形术与保守疗法治疗腰椎间盘突出症的对比研究.中国脊柱脊髓杂志,2005,15(12):722~725.
[4]何明伟,于密生,孙海燕,等.硬膜外前、侧间隙置管持续注药联合臭氧治疗颈椎间盘突出症的疗效分析.中国康复医学杂志,2012,27(8):741~743.
[5]赵家贵,朱本藩,宋阳,等.CT引导经黄韧带颈后路注射臭氧联合胶原酶治疗颈椎间盘突出症的疗效分析.中国疼痛医学杂志,2015,21(1):43~46.
[6]赵治涛,张增臻,肖珂青,等.CT引导下低温等离子靶点消融治疗颈椎间盘突出症的效果观察.实用放射学杂志,2016,32(7):1106~1108.
[7]王立奎,朱本藩,赵家贵,等.低温等离子射频消融联合O3及消炎镇痛液治疗包容性双节段腰椎间盘突出症的疗效分析.中国疼痛医学杂志,2018,24(6):435~439.
[8]Abrishamkar S,Salimi S,Pirmoradi H.Comparison the postoperation results of discectomy with nucleoplasty in single cervical disc herniation.Advanced Biomedical Research,2018,7(1):29.
[9]Yang CS,Zhang LJ,Sun ZH,et al.Acute prevertebral abscess secondary to intradiscal oxygen-ozone chemonucleolysis for treatment of a cervical disc herniation.JInt Med Res,2018,46(6):2461~2465.
[10]HE JL.Clinical study of CT guided laser ablation combined with collagenase injection and Huoxueshujin prescription in the treatment of lumbar disc herniation.J Minim Invas Med,2016.
[11]Wang ZJ,Zhu MY,Liu XJ,et al.Cervical intervertebral disc herniation treatment via radiofrequency combined with low-dose collagenase injection into the disc interior using an anterior cervical approach.Medicine,2016,95(25):e3953.
[12]张绍杰,侯会文,刘洋,等.经皮旋切术联合胶原酶靶点溶解治疗颈椎间盘突出症.中国疼痛医学杂志,2011,17(3):160~162.
[13]Wu SL,Li X,Lin C,et al.CT-guided nucleoplasty with radiofrequency energy for the treatment of lumbar disc herniation.J Spinal Disord Tech,2015,28(1):9~16.
[14]He L,Yue J,Yang L,et al.Cervicogenic headache alleviation after cervical coblation nucleoplasty:A prospective cohort study.Medicine,2016,95(39):e4786.
[15]怀昌,汪懿,陈永权,等.经皮等离子消融术治疗国人颈椎间盘突出症临床效果的Meta分析.山东医药,2016,56(16):50~52.
[16]Oh HS,Hwang BW,Park SJ,et al.Percutaneous endoscopic cervical discectomy(PECD):an analysis of outcome,causes of reoperation.World Neurosurg,2017,102:583~592.