Sutton J C
Clin Orthop Relat Res. 1986 May(206):56-60.
Of 208 chemonucleolysis procedures performed between April 1973 and June 1978, 189 (91%) were available for follow-up evaluation by comprehensive questionnaire after six to 11.2 years. Pain relief, activity level, and personal satisfaction are considered in patients otherwise eligible for discectomy. The procedures were done under general anesthesia with 18-gauge single needle technique using biplane image intensification and routine discography prior to Discase injection. Seventy-nine percent of patients were satisfied with their results, 85% males and 65% females. Sixty-two percent of workman's compensation patients and 57% of patients previously treated by laminectomy had a satisfactory result. Ninety-five percent of patients had disc space narrowing postoperatively. Complications were few and of no lasting concern. Of the failures, 12.7% had laminectomies within 18 months of injection while 9.5% had a satisfactory result for at least two years. Disc reexpansion was demonstrated after postinjection narrowing in 14% of 58 cases roentgenographically evaluated, including patients of the 2nd, 3rd, and 4th decade of life. Recurrence rate in the total series was 9.5%. Chemonucleolysis is the least traumatic invasive procedure capable of removing the nucleus pulposus and is most effective when used in the treatment of lumbar disc herniation with objective signs of nerve root compression. In this series, approximately 80% of patients were spared open surgery.
在1973年4月至1978年6月间进行的208例化学髓核溶解术中，189例（91%）在6至11.2年后通过综合问卷进行了随访评估。对原本适合进行椎间盘切除术的患者，考虑了疼痛缓解情况、活动水平和个人满意度。手术在全身麻醉下进行，采用18号单针技术，使用双平面影像增强器，并在注射DisCase前进行常规椎间盘造影。79%的患者对结果满意，其中男性为85%，女性为65%。62%的工伤赔偿患者和57%先前接受过椎板切除术的患者结果令人满意。95%的患者术后椎间盘间隙变窄。并发症很少，且没有长期影响。在失败的病例中，12.7%在注射后18个月内接受了椎板切除术，而9.5%至少两年内结果令人满意。在58例接受X线评估的病例中，14%在注射后狭窄的椎间盘在X线下显示有再扩张，包括20至40岁的患者。整个系列的复发率为9.5%。化学髓核溶解术是能够去除髓核的创伤最小的侵入性手术，用于治疗有神经根压迫客观体征的腰椎间盘突出症时最为有效。在本系列中，约80%的患者避免了开放性手术。
