经皮激光汽化联合靶点射频消融治疗腰椎间盘突出症的疗效观察

尹君 曾振华 严敏 戴仪 邓硕 邹三宝

·诊治分析·

经皮激光汽化联合靶点射频消融治疗腰椎间盘突出症的疗效观察

尹君 曾振华 严敏 戴仪 邓硕 邹三宝

目的 探讨经皮激光汽化联合靶点射频消融术治疗腰椎间盘突出症（LDH）的临床疗效和安全性。方法 LDH患者110例，55例患者应用经皮激光汽化椎间盘减压术（PLDD）联合靶点射频消融治疗为A组，55例应用PLDD治疗为B组。所有患者均随访6～27个月，应用改良MacNab评价标准比较两组患者最后随访时疗效，并比较两组不良反应。结果 A组优良率高于B组（P＜0.05）；两组有效率比较差异无统计学意义（P＞0.05）。结论 经皮激光汽化联合靶点射频消融治疗腰椎间盘突出症的优良率更高，不良反应少，是一种更好的微创治疗方法。

腰椎间盘突出症 激光减压 靶点射频消融

Objective To evaluate the clinical effects and safety of pereutaneous laser disc decompression（PLDD）compound radiofrequency target thermocoagulation ablation on lumbar disc herniation. Methods 110 patients diagnosed as lumbar disc herniation were selected and divided into two groups. Group A（55 cases）underwent PLDD and radiofrequency target thermocoagulation ablation，Group B（55 cases）underwent PLDD only. All patients were followed up for 6～27th month after treatment，The clinical results were assessed separately according to improved Macnab method. The adverse reactions were compared between the two groups. Results The excellent rate of group A was higher than that of group B（P＜0.05）. There was no significant difference between the two groups in the effective rate（P＞0.05）. Conclusion PLDD combined with radiofrequency target thermocoagulation ablation is an better minimally invasive therapy for the lumbar disc herniation，which has a higher excellent rate and lower adverse reactions.

【Abstract】 Lumbar disc herniation Laser disc decompression Radiofrequency target thermocoagulation ablation

腰椎间盘突出症（lumbar disc herniation，LDH）的治疗包括药物和物理保守治疗、神经阻滞、微创经皮穿刺和开放手术治疗。近年来，随着微创介入手术飞速发展，患者对其接受程度日益增高。经皮激光汽化椎间盘减压术（Pereutaneous laser disc decompression，PLDD）便是其中之一，Abrishamkar等［1］研究认为PLDD术与开放手术治疗LDH疗效无差异，且PLDD术创伤小、恢复快、费用低。但单纯使用PLDD也存在减压效果不足，尤其是不能太靠近突出靶点。作者采用PLDD联合靶点射频消融治疗LDH患者110例，疗效满意，现报道如下。

1 临床资料

1.1 一般资料 2012年10月至2015年12月嘉善县第一人民医院LDH患者110例，男51例，女 59例；年龄35～76岁。病程4个月～25年。共介入治疗椎间盘 149 个：L2～3突出 5 例，L3～4突出 27 例，L4～5突出 63 例，L5～S1突出54例。介入2个椎间盘38例。55例应用PLDD联合靶点射频治疗消融治疗为A组；……