Lecuire F, Jaffar-Bandjee Z, Basso M, Sorba L, Honoré M, Rebouillat J
Service de Chirurgie orthopédique, Hôpital Renée Sabran, Giens, Hyères.
Rev Chir Orthop Reparatrice Appar Mot. 1994;80(6):468-75.
This study is an attempt to assess the effects of chemonucleolysis over an extended period of time (8 to 12 years follow-up).
From 1981 to 1985, chemonucleolysis using Chymopapain was performed on 134 patients for the relief of radicular pain from herniated lumbar discs. The long term results were evaluated in 110 patients. This represented a total follow-up rate of 82 per cent. 24 patients were lost to follow-up.
Of the 110 patients who had been reviewed at 8 to 12 years follow-up: 76 patients did not need other treatment than the initial chemonucleolysis. The results were excellent or good in 69 patients (63 per cent) and fair in 7 patients (6 per cent). 34 required surgery (31 per cent). This rate does not reflect the real failure rate of chemonucleolysis: 7 patients underwent early surgery and corresponded with the beginning of our experience with chemonucleolysis. 7 patients needed surgical treatment after a successful initial result for two to nine years. The real failure rate concerned 19 patients (17 per cent). These patients did not have any pain relief following chemonucleolysis. Surgical treatment was undertaken on the average 18 months after chemonucleolysis. One patient had suffered from radicular pain 6 years following the first chemonucleolysis. In this case, iterative chemonucleolysis had been done on the same lumbar level. It was effective on the radicular pain but not on the back pain. Chemonucleolysis had been effective in 70 per cent of the patients.
Our study showed that the long term results following chemonucleolysis were effective and the mortality rate was low. (No severe complication in this study). This study is compared with the literature, studying the results of chemonucleolysis patients, or comparing patients treated by chymopapain or surgical discectomy.
We conclude that chemonucleolysis is an effective and safe method for treating sciatica by herniated lumbar discs.
本研究旨在评估化学髓核溶解术在较长时间段（8至12年随访）内的效果。
1981年至1985年期间，对134例因腰椎间盘突出症导致神经根性疼痛的患者进行了木瓜凝乳蛋白酶化学髓核溶解术以缓解疼痛。对110例患者的长期结果进行了评估。总体随访率为82%，24例患者失访。
在110例接受了8至12年随访的患者中：76例患者除了最初的化学髓核溶解术外无需其他治疗。69例患者（63%）结果为优或良，7例患者（6%）结果为一般。34例患者（31%）需要手术治疗。这个比例并未反映化学髓核溶解术的实际失败率：7例患者早期接受了手术，这与我们刚开始进行化学髓核溶解术的情况相符。7例患者在最初效果良好的两至九年后需要手术治疗。实际失败率涉及19例患者（17%）。这些患者在化学髓核溶解术后疼痛未得到任何缓解。化学髓核溶解术后平均18个月进行了手术治疗。1例患者在首次化学髓核溶解术后6年仍患有神经根性疼痛。在此病例中，在同一腰椎节段进行了反复化学髓核溶解术。对神经根性疼痛有效，但对背痛无效。化学髓核溶解术在70%的患者中有效。
我们的研究表明，化学髓核溶解术的长期效果良好且死亡率低。（本研究中无严重并发症）。本研究与文献进行了比较，文献研究了化学髓核溶解术患者的结果，或比较了接受木瓜凝乳蛋白酶治疗或手术椎间盘切除术的患者。
我们得出结论，化学髓核溶解术是治疗腰椎间盘突出症所致坐骨神经痛的一种有效且安全的方法。
