摘要
背景与目的
腰椎间盘突出症(lumbar disc herniation,LDH)是引起腰腿痛的重要原因,介入治疗LDH方法主要有经皮腰椎间盘摘除术(percutaneous lumbar diskectomy,PLD)、臭氧髓核消融术(O_3)、胶原酶化学溶解术(chemonucleolysis,CN)等,本文主要探讨:1.纤维环破裂与否对介入治疗方法选择的影响:2.腰椎间盘纤维环完整性与免疫球蛋白IgG,IgM含量的相关性。
方法
在X线透视引导下,先行盘内注入低浓度O_2-O_3混合气体,确定纤维环是否完全破裂,将LDH分为破裂型(149例)和完整型(251例)。完整型中行PLD治疗85例,O_3 87例,胶原酶79例;破裂型中行PLD治疗30例,O_3 29例,胶原酶43例,O_3+胶原酶47例。
在400例LDH中选取106例患者,于术前采用散射免疫浊度法测定71例完整型突出与35例破裂型突出外周血清IgG、IgM含量,同时测定30例正常人血清IgG、IgM含量作为对照组。
术后3～6月判定疗效,根据改良的Macnab方法评价疗效。
结果
完整型LDH介入治疗:PLD、O_3、胶原酶三种方法比较,疗效无显著性差异;并发症发生率比较均有显著性差异。
破裂型LDH介入治疗:O_3+胶原酶疗效明显优于单纯PLD、O_3治疗,O_3+胶原酶与单纯胶原酶注射间疗效无显著性差异;胶原酶与O_3、O_3+胶原酶之间并发症发生率有显著性差异。
PLD、O_3对完整型与破裂型LDH疗效有显著差异,完整型优于破裂型(P＜0.05),胶原酶对完整型与破裂型LDH疗效无显著差异(P＞0.05)。
破裂型与完整型、正常对照组间血清IgG、IgM含量有显著差异(P＜0.05),完整型LDH与正常对照组无显著差异(P＞0.05),破裂型高干完整型。
结论
1.完整型LDH,单纯PLD、O_3或胶原酶注射均是有效方法,不必联合应用,O_3并发症发生率最低。对于破裂型LDH,O_3+胶原酶治疗是最为有效和安全的微创治疗方法。
2.血清IgG、IgM含量与LDH的病理分型有相关性,对破裂型LDH具有一定辅助诊断价值。
Objective
To study the effect of the annulus fibrosus rupture or intact on the selection ofinterventional therapeutic methods and the relationship of the serum immunoglobinIgG, IgM with annulus fibrosus intact or not in lumbar disc herniation (LDH).
Methods
Under the X-ray guidance,the discography was carried out with 5ml low concentrationO2-O3 mixture injection in lumbar intradisc before the interventional therapy. On thebasis of the discography,400 patients were classified into two types:rapture(n=149) andintact(n=251) disc herniations.
Then different therapeutic methods were chosen in intact disc herniations,85 cases withPLD,87 cases with O_3, 79 cases with collagenase;in rupture disc herniations,30 caseswith PLD,29 cases with O_3,43 cases with collagenase,47 cases with O3 combinedCollagenase.
Seventy one cases with intact discs and 35 cases with rupture discs were invovled in thestudy of immune status, the levels of IgG and IgM in serum were examined beforeinterventional therapy by rate nephetometry,at the same time,which were compared withnormal control of 30 cases each other.
After the treatment of 3-6 months,the follow-up results were assessed according to theimproved Macnab criteria.
Results
1. In intact disc herniations group,there is no significant difference about therapeuticeffect among the three methods of PLD, O3, collagenase, but the complications with significant difference.
2. In rupture disc herniations group,there is significant difference about therapeuticeffect between the treatment O_3 combined Collagenase and simple O_3, PLD,but nodifference was found between treatment of O_3 combined Collagenase and simpleCollagenase. The complications of Collagenase were significant higher than those withO_3,O_3 combined Collagenase.
3.Great difference existed between intact and rupture disc herniations with treatment ofPLD and O_3 (P<0.05),but there were no difference for collagenase(P>0.05).
4.The levels of serum IgG and IgM in rupture disc herniations were higher than intactdisc herniations before interventional therapy with significant difference(P<0.05),but nosignificant difference was found between intact disc herniations and normalcontrol(P>0.05).
Conclusions
1.Simple PLD,O_3 or Collagenase injection are all effective interventional methods forintact disc herniations,but the complications of O3 are the lowest among them.
2.O_3 combined Collagenase injection is the most effective and safe interventionalmethod for rupture disc herniations and should be the first choice.
3.The levels of serum IgG and IgM have correlation with the pathologic types ofLDH ,which is useful for predicting rupture or not of disc herniations.
引文
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