CT导向下颈椎间盘突出的臭氧消融治疗.doc

CT导向下颈椎间盘突出的臭氧消融治疗 1肖越勇　2孟晓东　1李家开　3廖正银　4王金良　5李继亮　6陈 春　2王广洲 　 1解放军总医院　2北京房山中医院　3四川大学华西医学院附属医院　4河南平顶山第五医院 5山西原平铁路医院 6四平市中心医院 摘要　目的：探讨CT导向下臭氧术治疗。方法：例颈椎间盘突出患者其中 CT导向下穿刺途径为前斜向穿刺于盘内注射浓度为60ug/ml-7ml，平均4ml；椎旁组织内注射40ug/ml浓度的臭氧5ml。11例患者因合并颈型颈椎病患者感颈肩部疼痛于消融术1周后进行了颈部背侧肌内臭氧注射。结果：注射臭氧后CT扫描显示臭氧在间盘内分布治疗后3个月随访显效、有效和无效者分别占78%、16%及6%；结论：CT导向下臭氧，为椎间盘突出治疗的方法。关键词脊椎；间盘突出；化学术；臭氧；CT；穿刺CT guided O3 injection for the treatment of cervical spondylosis X IAO Yueyong1, MEN G Xiaodong2 ,LI Jiakai1, LI J iliang3 , CHEN Chun4, LIAO Zhengying5, WANG Guangzhou2. 1. Department of Radiology, PL A General Hospital , Beijing 100853 , China ABSTRACT　Objective 　To explore the value of CT guided O3 injection in the treatment of cervical spondylosis. Methods All 86 patients cervical spondylosis including type of myelopathy 37 cases, type of radiculopathy 30 cases, and sympathetic type 16 cases were treated with O3 injection under the guidance of CT. The puncture rout was from the anteroparaline of neck to the disk. A total of 2-7 ml of ozone with concentration 60μg/ml were injected both to disk and 5ml of ozone with concentration 40μg/ml were injected to the paraspinal tissue. Results 　After injection of ozone, the ozone were distributed within the disk and HNP. The excellent, good and poor clinical efficacy was 78 %, 16 % and 6 % , respectively 3 months after treatment. Conclusion 　CT guided O3 injection is an accurate, safe, and effective method in the treatment of cervical spondylosis. KEY WORDS 　Intervertebral disk displacement; Ozone; Cervical spondylosis; Therapy, interventional  即往颈椎间盘突出的臭氧消融治疗是在C型臂透视导向下进行[1]，因注射剂量和盘内分布不易掌握，影响治疗效果，目前国内外尚未见CT导向下颈椎间盘突出臭氧消融治疗的报道。笔者采用CT导向技术，通过精确穿刺、合理控制臭氧的注射剂量及其在颈椎间盘内、突出物和椎旁的弥散分布以提高疗效，现在报道如下。 材料与方法 1一般资料：2002年7月至2005年12月期间治疗颈椎间盘突出86例，其中男57例，女29例，年龄36-72岁，平均52岁。全部患者术前均行CT和MRI检查， 排除了颈段椎管骨性狭窄、后纵韧带骨化，MRI T2WI矢状位图像未见脊髓软化改变。按照颈椎病分型标准[2]，根据本组患者临床表现和影像学改变本组病例脊髓型：37例；神经根型：30例；交感型：19例；本组患者有11例并颈型颈椎病。椎动脉型颈椎病没有纳入本组病例。山东淄博悦华医疗器械有限公司生产的医用臭氧发生器。 2穿刺途径：全部患者经颈部侧前方穿刺颈椎间盘，C3-4间盘经颈动脉鞘内缘和