摘要目的 探讨CT引导下低温等离子射频消融术联合胶原酶治疗腰椎间盘突出症的临床疗效.方法 对58例腰椎间盘突出症患者行CT引导下靶点低温等离子射频消融术合并胶原酶治疗.采用VAS评分标准及MacNab评定标准评估手术前后疼痛程度的变化,记录术后恢复时间和疼痛缓解时间以及术后疼痛缓解的相关危险因素分析.结果 所有患者均穿刺成功,且术后未出现神经损伤、椎间盘感染,无脊髓、血管脏器损伤等并发症.术后行6个月定期随访,术后2周VAS评分平均3分;术后1个月VAS评分平均2.6分,与术后2周比较差异有统计学意义(P＜0.05);术后3个月达到稳定状态,VAS评分平均1.3分,与术后2周比较差异有统计学意义(P＜0.05);术后6个月VAS评分平均1.2分,与术后3个月比较无明显改善,差异无统计学意义(P＞0.05).MacNab评估结果为优的患者共30例(51.7％),评价结果为良的患者共15例(25.8％),评价结果为可的患者共8例(15.5％),评价结果为差的患者共5例(7％),优良率达到89.7％.结论 多种微创技术联合治疗腰椎间盘突出症安全有效,值得临床推广应用.

abstractsObjective To investigate the efficacy of CT-guided low-temperature plasma-mediated radiofrequency ablation combined with collagenase in the treatment of prolapse of lumbar intervertebral disc.Methods A total of fifty-eight patients with prolapse of lumbar intervertebral disc received low-temperature plasma-mediated radiofrequency ablation combined with collagenase were retrospectively analyzed.Changes in the degree of pain before and after operation were evaluated by VAS.The duration of postoperative recovery and pain relief were recorded.Risk factors for postoperative pain relief were analyzed.Results All patients underwent successful puncture,and no neurological injury,intervertebral disc infection,and no complications such as spinal cord and vascular organ injury.Postoperative follow-up for 6 months,the mean VAS was 3 points after 2 weeks.The mean VAS was 2.6 points at 1 month postoperatively,which was statistically different from the 2 weeks postoperatively (P＜0.05).The stable state was achieved at 3 months after surgery,with an average of 1.3 points,compared with 2 weeks after surgery.There was a statistical difference (P＜0.05).The mean VAS was 1.2 points at 6 months after operation,and there was no significant improvement compared with 3 months after operation.The difference was not statistically significant (P＞0.05).MacNab evaluation was excellent.A total of 30 patients (51.7％) had a good evaluation of 15 patients (25.8％),and 8 patients (15.5％) had a good evaluation.The patients with poor results were 5 patients (7％).The excellent rate reached 89.7％.Conclusions Low-temperature plasma-mediated radiofrequency ablation combined with collagenase can effectively treat prolapse of lumbar intervertebral disc.These two techniques are both characterized by safety and minimal trauma.Thus,this method is recommended for combined minimally invasive interventional therapy in addition to conservative therapy and open surgery.