Wang Meng, Zhang Xuexue, Yu Yaoping, Xu Gang, Nie Jinping, Yu Bo, Cao Xuezhong, Qiu Mizhen, Liao Yunhua, Zhang Daying, Yan Yi
Department of Pain Medicine, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China.
Graduate School of Jiangxi Medical College, Nanchang University, Nanchang 330006, China.
Evid Based Complement Alternat Med. 2021 Dec 23;2021:8234558. doi: 10.1155/2021/8234558. eCollection 2021.
This study explored the 10-year efficacy, safety, and prognostic factors of low-dose collagenase chemonucleolysis (CCNL) combined with radiofrequency (RF) in the treatment of lumbar disc herniation (LDH).
The data of 167 LDH patients were collected. Modified MacNab criteria, Numerical Rating Scale (NRS), and Japanese Orthopedic Association (JOA) scores were, respectively, used to evaluate patients' excellent and good rates, pain degree, and nerve function. The preoperative and 10-year postoperative patients' pain, numbness, and muscle weakness were compared. Patients' complications in perioperative period, recurrent/reappeared LDH, and reoperations were recorded. Finally, the independent risk factors affecting the long-time efficacy were assessed.
A total of 126 patients were included. The patients' excellent and good rates were 86.51%-92.86% with no significant difference ( > 0.05). Postoperative NRS and JOA scores significantly improved ( < 0.01), most obvious within 6 months postoperatively. At 10 years postoperatively, 65.08%, 83.95%, and 93.02% of patients' pain, numbness, and muscle weakness were completely relieved ( < 0.05). Perioperative complications occurred in three patients with the rate of 2.38%. Recurrent/reappeared LDH patients were 11 with the ratio of 8.73%; nine of them underwent reoperations with the rate of 7.14%. And patients' probability of fair and poor efficacy at 10 years postoperatively with the course of disease >12 months and the responsibility disc ≥2 were, respectively, 6.005 and 4.227 times that of patients with the course of disease ≤12 months and the responsibility disc = 1 ( < 0.05).
The combined treatment is effective and safe in the long term. A course of disease 12 months and responsibility disc ≥2 independently reduce efficacy, and a course of disease 12 months has a more significant impact.
本研究探讨低剂量胶原酶化学溶解术（CCNL）联合射频（RF）治疗腰椎间盘突出症（LDH）的10年疗效、安全性及预后因素。
收集167例LDH患者的数据。分别采用改良MacNab标准、数字评定量表（NRS）和日本骨科协会（JOA）评分评估患者的优良率、疼痛程度和神经功能。比较术前及术后10年患者的疼痛、麻木和肌肉无力情况。记录患者围手术期并发症、复发性/再发性LDH及再次手术情况。最后，评估影响长期疗效的独立危险因素。
共纳入126例患者。患者优良率为86.51% - 92.86%，差异无统计学意义（>0.05）。术后NRS和JOA评分显著改善（<0.01），术后6个月内最明显。术后10年，65.08%、83.95%和93.02%的患者疼痛、麻木和肌肉无力完全缓解（<0.05）。3例患者发生围手术期并发症，发生率为2.38%。复发性/再发性LDH患者11例，比例为8.73%；其中9例接受再次手术，发生率为7.14%。病程>12个月且责任椎间盘≥2的患者术后10年疗效为中等及差的概率分别是病程≤12个月且责任椎间盘=1的患者的6.005倍和4.227倍（<0.05）。
联合治疗长期有效且安全。病程>12个月和责任椎间盘≥2独立降低疗效，病程>12个月的影响更显著。
