D'Erme M, Scarchilli A, Artale A M, Pasquali Lasagni M
Istituto Chirurgico Ortopedico Traumatologico (I.C.O.T.), Latina.
Radiol Med. 1998 Jan-Feb;95(1-2):21-4.
Medical ozone is a mixture of oxygen and ozone which can be used for several medical applications. Ozone was first applied clinically to the treatment of lumbar sciatic pain peridurally, while Pietrogrande was the first in Italy to report on its intradiscal administration to treat nucleus polposus herniation. On account of these considerations, we have decided to introduce this method in our Institute (I.C.O.T. Latina) as an alternative to surgery in the treatment of lumbar sciatic pain supported by an intradiscal hernia.
September, 1995, to April, 1997, we treated more than 1000 patients with intradiscal ozone infiltration. We prospectively analyzed the first 50 patients, with 6 months' follow-up at least; all of them were preliminarily submitted to clinical examination, electromyography, CT and MRI. After local anesthesia, we injected the disk, with 18-20 G needles and under CT or fluoroscopic guidance, with 12 ml of a mixture of oxygen and ozone at a concentration of 20-30 micrograms/ml. The treatment was repeated two or three more times at intervals of 3, 15 or, when necessary, 30 days. After each treatment, CT follow-ups were carried out and the final follow-up was made 3 months later.
We divided our results into clinical and instrumental. As for clinical response, we had 68% positive results (40% excellent, 28% good) and 32% negative results (10% of patients underwent surgery and 22 are under medical and physical treatment). As for CT response, we had 82% positive results (36% excellent, 46% good), while no major changes between pre- and post-treatment CT findings in the remaining 18% of cases.
Ozone therapy, thanks to its ease of execution and noninvasiveness, permits the successful outpatient treatment of lumbar sciatic pain. Moreover, the lack of major complications and the good results obtained compared to other methods, such as chemonucleolysis, percutaneous automated discectomy, microsurgery and conventional surgery, suggest that ozone therapy can be considered the treatment of choice for lumbar sciatic pain and a valid alternative to surgery in many cases.
医用臭氧是氧气和臭氧的混合物,可用于多种医疗应用。臭氧最早临床应用于硬膜外治疗腰椎坐骨神经痛,而彼得罗格兰德是意大利首个报道将其用于椎间盘内注射治疗椎间盘突出症的人。基于这些考虑,我们决定在我们研究所(拉蒂纳国际骨科治疗中心)引入这种方法作为手术的替代方案,用于治疗由椎间盘疝引起的腰椎坐骨神经痛。
1995年9月至1997年4月,我们对1000多名患者进行了椎间盘内臭氧注射治疗。我们对前50名患者进行了前瞻性分析,至少随访6个月;所有患者均先接受临床检查、肌电图、CT和MRI检查。局部麻醉后,我们在CT或荧光镜引导下,用18 - 20G针头向椎间盘内注射12毫升浓度为20 - 30微克/毫升的氧气和臭氧混合液。治疗每隔3天、15天或必要时30天重复进行两到三次。每次治疗后进行CT随访,最后一次随访在3个月后进行。
我们将结果分为临床和影像学两方面。在临床反应方面,我们有68%的阳性结果(40%为优,28%为良)和32%的阴性结果(10%的患者接受了手术,22名患者正在接受药物和物理治疗)。在CT反应方面,我们有82%的阳性结果(36%为优,46%为良),而其余18%的病例治疗前后CT表现无重大变化。
臭氧疗法因其操作简便且无创,使得门诊治疗腰椎坐骨神经痛取得成功。此外,与其他方法如化学髓核溶解术、经皮自动椎间盘切除术、显微手术和传统手术相比,臭氧疗法缺乏重大并发症且效果良好,这表明臭氧疗法可被视为腰椎坐骨神经痛的首选治疗方法,并且在许多情况下是手术的有效替代方案。