椎间盘内+小关节臭氧注射治疗腰椎间盘突出症的临床研究
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摘要
目的:比较腰椎间盘内臭氧注射与腰椎间盘及小关节臭氧注射治疗椎间盘突出症疗效有无差异,为临床上更合理的使用臭氧治疗腰腿痛提供参考。
方法:32例伴有腰痛症状的椎间盘突出症患者,年龄23～69岁、男女不限,随机分为2组(对照组和实验组)每组16例,对照组为椎间盘内臭氧注射组(Lumbar Disc,D组);实验组为椎间盘及小关节内臭氧注射组(Facet Joint,F组)。D组在CT引导下穿刺成功后于椎间盘内用分次缓慢注入氧—臭氧混合气体10～30mL(臭氧浓度:60ug/mL),后退针至椎间孔外口附近注入氧—臭氧混合气体10mL(臭氧浓度40ug/mL)。F组在CT引导下穿刺成功后于盘内用分次缓慢注入氧—臭氧混合气体10～30mL(臭氧浓度:60ug/mL),后退针至椎间孔外口附近注入氧—臭氧混合气体10mL(臭氧浓度:40ug/mL),然后在于病变间盘双侧小关节囊内注入氧—臭氧混合气体5mL、退针至囊外注入5mL(臭氧浓度:30ug/mL)。所有患者术后均在急诊科观察3～5天。观察项目包括:术前腰痛、腿痛VAS评分及直腿抬高度数;术中患者血压、心率和血氧饱和度以及穿刺针旁开后正中线的距离、穿刺角度和深度;术中臭氧使用量;术中不良反应和手术时间。
结果:两组术前资料没有统计学差异(P＞0.05);两组术中心率、平均动脉压和血氧饱和度之间均无统计学差异(P＞0.05);两组间椎间盘内的氧—臭氧用量没有统计学差异(P＞0.05),但氧—臭氧的总用量有差异(P＜0.05);单纯腰椎间盘内臭氧注射组术后腰痛消失的例数要少于腰椎间盘及小关节内臭氧注射组(P＜0.05),但腿痛、腿麻的症状及直腿抬高改善情况两组间没有差异(P＞0.05),腰椎间盘内臭氧注射组总的不良反应发生率低于腰椎间盘及小关节内臭氧注射组,有统计学差异(P＜0.05)。3个月后,腰椎间盘内臭氧注射组显效率(50.0%)低于腰椎间盘及小关节臭氧注射组(75.0%)(P＜0.05),而改善率(37.5%)高于腰椎间盘及小关节内臭氧注射组(12.5%);腰椎间盘内臭氧注射组总有效率(87.5%)与腰椎间盘及小关节内臭氧注射组总有效率(87.5%)没有统计学差异(P＞0.05)。
结论:腰椎间盘内及小关节臭氧注射的治疗方法适用于伴有腰痛的椎间盘突出症患者,其疗效优于单纯腰椎间盘内臭氧注射疗法;腰椎间盘内及小关节臭氧注射组腰痛改善明显好于单纯椎间盘内臭氧注射组;本研究的不良反应发生率并不增加。
Objective: Oxygen-ozone therapy is a minimally invasive treatment for lumbar disk herniation that exploits the biochemical properties of a gas mixture of oxygen and ozone. We assessed the therapeutic outcome of oxygen-ozone therapy and compared the outcome of administering medical ozone in lumbar intradiscal with the outcome of medical ozone followed by injection of oxygen-ozone in lumbar intradiscal and the same session facet joints capsule.
Methods: Thirty-two patients presented with clinical signs of lumbar disk nerve root compression and low back pain, with CT and/or MRI evidence of contained a single session disk herniation. All were randomly divided control group (group D) and experimental group (group F), each group had sixteen patients. Sixteen patients (group D) received lumbar disc injection of an oxygen-ozone mixture at an ozone concentration of 60ug/mL and foramen intervertebrale (periganglionic) injection of an oxygen-ozone mixture at an ozone concentration of 40ug/mL. The other thirteen patients (group F) received the same as group D, in addition, the facet joints of the same session injection of an oxygen-ozone mixture 10mL at an ozone concentration of 30ug/mL. To observe the preoperative conditions of the patients including of low back pain and numbness leg and the adverse events in operation. Therapeutic outcome was assessed at the 1st, 2nd and 3rd month after treatment by recovery of low back pain, leg pain and leg paralysis. After 3 months, a MacNab method was evaluated therapeutic outcome. Results were evaluated by two observers blinded to patient distribution within the two groups.
Results: In group D, treatment was a success (excellent or good outcome) in 87.5% which was excellent in 50% and good in 37.5%. In group F, treatment was a success in 87.5% which was excellent in 75.0% and good in 12.5%. The difference in excellent or good outcome between the two groups was statistically significant. The difference of adverse events incidence was not statistically significant between the two groups.
Conclusion: The outcome of medical ozone followed by injection of oxygen-ozone in lumbar intradiscal and the same session facet joints was better chan the outcome of administering medical oxygen-ozone in lumbar intradiscal. Administering ozone in facet joints could relieve low back pain. And to increase the quantity of oxygen-ozone could not raise the incidence of adverse events.
方法:32例伴有腰痛症状的椎间盘突出症患者,年龄23～69岁、男女不限,随机分为2组(对照组和实验组)每组16例,对照组为椎间盘内臭氧注射组(Lumbar Disc,D组);实验组为椎间盘及小关节内臭氧注射组(Facet Joint,F组)。D组在CT引导下穿刺成功后于椎间盘内用分次缓慢注入氧—臭氧混合气体10～30mL(臭氧浓度:60ug/mL),后退针至椎间孔外口附近注入氧—臭氧混合气体10mL(臭氧浓度40ug/mL)。F组在CT引导下穿刺成功后于盘内用分次缓慢注入氧—臭氧混合气体10～30mL(臭氧浓度:60ug/mL),后退针至椎间孔外口附近注入氧—臭氧混合气体10mL(臭氧浓度:40ug/mL),然后在于病变间盘双侧小关节囊内注入氧—臭氧混合气体5mL、退针至囊外注入5mL(臭氧浓度:30ug/mL)。所有患者术后均在急诊科观察3～5天。观察项目包括:术前腰痛、腿痛VAS评分及直腿抬高度数;术中患者血压、心率和血氧饱和度以及穿刺针旁开后正中线的距离、穿刺角度和深度;术中臭氧使用量;术中不良反应和手术时间。
结果:两组术前资料没有统计学差异(P＞0.05);两组术中心率、平均动脉压和血氧饱和度之间均无统计学差异(P＞0.05);两组间椎间盘内的氧—臭氧用量没有统计学差异(P＞0.05),但氧—臭氧的总用量有差异(P＜0.05);单纯腰椎间盘内臭氧注射组术后腰痛消失的例数要少于腰椎间盘及小关节内臭氧注射组(P＜0.05),但腿痛、腿麻的症状及直腿抬高改善情况两组间没有差异(P＞0.05),腰椎间盘内臭氧注射组总的不良反应发生率低于腰椎间盘及小关节内臭氧注射组,有统计学差异(P＜0.05)。3个月后,腰椎间盘内臭氧注射组显效率(50.0%)低于腰椎间盘及小关节臭氧注射组(75.0%)(P＜0.05),而改善率(37.5%)高于腰椎间盘及小关节内臭氧注射组(12.5%);腰椎间盘内臭氧注射组总有效率(87.5%)与腰椎间盘及小关节内臭氧注射组总有效率(87.5%)没有统计学差异(P＞0.05)。
结论:腰椎间盘内及小关节臭氧注射的治疗方法适用于伴有腰痛的椎间盘突出症患者,其疗效优于单纯腰椎间盘内臭氧注射疗法;腰椎间盘内及小关节臭氧注射组腰痛改善明显好于单纯椎间盘内臭氧注射组;本研究的不良反应发生率并不增加。
Objective: Oxygen-ozone therapy is a minimally invasive treatment for lumbar disk herniation that exploits the biochemical properties of a gas mixture of oxygen and ozone. We assessed the therapeutic outcome of oxygen-ozone therapy and compared the outcome of administering medical ozone in lumbar intradiscal with the outcome of medical ozone followed by injection of oxygen-ozone in lumbar intradiscal and the same session facet joints capsule.
Methods: Thirty-two patients presented with clinical signs of lumbar disk nerve root compression and low back pain, with CT and/or MRI evidence of contained a single session disk herniation. All were randomly divided control group (group D) and experimental group (group F), each group had sixteen patients. Sixteen patients (group D) received lumbar disc injection of an oxygen-ozone mixture at an ozone concentration of 60ug/mL and foramen intervertebrale (periganglionic) injection of an oxygen-ozone mixture at an ozone concentration of 40ug/mL. The other thirteen patients (group F) received the same as group D, in addition, the facet joints of the same session injection of an oxygen-ozone mixture 10mL at an ozone concentration of 30ug/mL. To observe the preoperative conditions of the patients including of low back pain and numbness leg and the adverse events in operation. Therapeutic outcome was assessed at the 1st, 2nd and 3rd month after treatment by recovery of low back pain, leg pain and leg paralysis. After 3 months, a MacNab method was evaluated therapeutic outcome. Results were evaluated by two observers blinded to patient distribution within the two groups.
Results: In group D, treatment was a success (excellent or good outcome) in 87.5% which was excellent in 50% and good in 37.5%. In group F, treatment was a success in 87.5% which was excellent in 75.0% and good in 12.5%. The difference in excellent or good outcome between the two groups was statistically significant. The difference of adverse events incidence was not statistically significant between the two groups.
Conclusion: The outcome of medical ozone followed by injection of oxygen-ozone in lumbar intradiscal and the same session facet joints was better chan the outcome of administering medical oxygen-ozone in lumbar intradiscal. Administering ozone in facet joints could relieve low back pain. And to increase the quantity of oxygen-ozone could not raise the incidence of adverse events.
引文
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10 Bocci V.Ozone as a bioregulator.Pharmacology and toxicology of ozone therapy today[J].Biol Regul Homeost Agents,1996,10(2、3):31-53.
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13 Fabris G.Oxygen-Ozone therapy for herniated cervical disc[J].Rivista Italiana diossigeno-Ozonoterapia,2003,2(N2):163-168.
14 Bocci V.Biological and clinical elects of ozone:has ozone therapy a future in medicine[J].Br J Biomed Sci,1999,56(4):270-279.
15 Gomez Moraleda MA.Ozone therapy in the functional recovery from diseases involing damage to central nervous system cells.In:International Ozone Association,ed.Proceedings:ozone in medicine[R].12th World Congress of the International Ozone Association,15-18 May 1995.Lille France.Tours:Instaprint SA,1995:111-23.
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17 Alexandre A,Buric J.Intradiscal injection of 02-O3 to treat lumbar disc herniations.Results at five years.Rivista Italiana di Ossigeno-oz0notherapia,2002,1(N2):165-169.
18 Muto M,Avella F.Percutaneous treatment of herniated lumbar disc by intradiscal oxygen ozone injection.Interventional Neuroradiology.1998.4(3): 273-286
19 HE Xiaofeng ,LI Yanhao , CHEN Hanwei, et al. Intradiscal inj ection of O2-O3 to treat lumbar disc herniations: clinical therapeutic effect analysis with 600 cases,[J],Interv Imaging Ther,2005,2(5):338-431
20 Choy DS. Percutaneous laser nucleolysis of lumbar disks[J]. N Engl Med. 1987. 317: 771-772.
21 Sherk HH. The use of lasers in orthopic procedure[J]. J Bone Jiont Surg, 1993,75(A): 768-776.
22 Choy D S J, Case RB, Fielding W, et al. Percutaneous laser nucleolysis of lumbar disc[J]. N Engl J Med, 1987, 317: 771-772.
23 Choy DS, Altman P. Fall of intradisc pressure with laser ablation [J],Laser Surg Med,1990; 2:30.
24 Donna D, Ohnmeiss MS, Richard D, et al. Laser disc decompression: The importance of proper patient selection [J]Spine, 1994,19(18)2054
25 Gangi A, Jean-Louis. Kietemann, JL, Christophe, et al. Percuraneous laser disk decompression under CT and fluoroscopic guidance: indications, technique and clinical experience [J], Scientific Exihibit, 1996,16(1):89-96
26 Choy DSPereutaneous laser disc decompression(PLDD): twelve years'experience with 752 procedure in 518 patients[J].J Clin Laser Med Surg,1998, 16(2): 325—331.
27 Knight M, Goswami A. Lumbar percutaneous KTP532 wavelength laser disc decompression and disc ablation in the management of the discogenic pain [J]. Clin Laser Med Surg, 2002, 20(1): 9-13.
28 黄祥龙,念丁芳,吕俊明,等.经皮穿刺激光腰椎间盘减压术的临床应用.中华放射学杂志,2000,34:203-205.
29 Wang CG,Hong QJ,Zhu HB,et al.Clinical application of percutaneous laser disk decompression.Chin J Laser Med Surg(Chinese),2001,10(1):30-34
30 游箭,牟玮,李强,等,经皮激光汽化减压术治疗腰椎间盘突出症的临床应用,第三军医大学学报,2004,26(21):1930-1932
31 Hijikata S,Yama shi M,Nakayama T,et al.Percutaneous diskectomy:Anew treatment method for lumbar disc herniation[J].J Toden Hosp,1975,39:5-13.
32 张鹏,陈伯华,周秉文。经皮穿刺髓核切吸术切吸量与疗效的关系,中国脊柱脊髓杂志,2001,11(4):229-230
33 车坚,张鹏,袁东堂。APLD治疗腰椎间盘突出症远期疗效观察,颈腰痛杂志,2002,23(3):190-192
34 Foley KT,Smith MM,Microendoscopic discectomy,[J].Tech Neurosurg,1997,3:301-307.
35 王欢.王海义.安春厚.经显微内窥镜手术治疗腰椎问突出症,[J].中华华骨科杂志,2002.22(1):17-19.
36 张春霖,唐恒涛,于远洋,等,腰椎后路椎间盘镜手术及疗效分析,中华骨科学杂志,2004,24(2):84-87
37 Perez-Cruet MJ,Foley KT,Isaacs RE,et al.Microendoscopic lumbar discectomy:technical note[J].Neurosurgery,2002,51(5):129-136.
38 Muramatsu K,Hachiya Y,Morita C.Postoperative magnetic resonance imaging of lumbar disc herniation:comparison of microendoscopic discectomy and Love's method[J].Spine,2001,26:1599-1605.
39 Tonami H, Kuginuki M, Kunlki Y, et al. MR imaging of subehondral osteOnecmsis of the vertebral body after percutaneous laser diskeetomy [J]. AJR. 1999, 173(5): 1383-1386.