邱觅真+万权+张达颖

摘 要 胶原酶化学溶解术治疗腰椎间盘突出症在临床应用已40余年。研究表明胶原酶注入病变椎间盘后水解胶原分子为相关氨基酸，最终被机体吸收，但其水解的具体过程仍待进一步研究。近年临床研究证明：注射部位和剂量与安全效果高度相关；小剂量胶原酶突出物注射或盘内外联合注射可获较好远期效果；小剂量胶原酶注射联合射频可减少正常椎间盘水解，提高整体效果，并已在椎间盘突出症治疗中证实。胶原酶化学溶解术仍是临床经典、安全及有效的微创治疗方法。

关键词 胶原酶 腰椎间盘突出症 化学溶解术

中图分类号：R681.53； R977.3 文献标识码：A 文章编号：1006-1533（2016）17-0005-05

Research progress in collagenase chemonucleolysis for the treatment of lumbar intervertebral disc herniation

QIU Mizhen， WAN Quan， ZHANG Daying*

（Department of Pain， the First Hospital affiliated to Nanchang University， Nanchang 330006， China）

ABSTRACT The clinical application of collagenase chemonucleolysis in the treatment of lumbar intervertebral disc herniation has been lasted for more than 40 years. Many studies have shown that the collagenase which is injected into the intervertebral disc can hydrolyze the collagen into amino acids which are finally absorbed by the human body. However， the specific process for its hydrolysis remains to be further studied. In recent years， clinical research has proved that the site and dose for the injection of collagenase are highly correlated with its safety and efficacy. A long-term and good result can be obtained by injection of low-dose collagenase into the protrusion or combination of intradiscal and epidural injection. The normal hydrolysis of intervertebral disc can be reduced by injection of low-dose collagenase into the disc interior combined with radiofrequency and the overall effect can be improved， which has been confirmed in the treatment of intervertebral disc herniation. Collagenase chemonucleolysis is a minimally invasive treatment method with high safety and effectiveness.

KEY WORDS collagenase； lumbar intervertebral disc herniation； chemonucleolysis

胶原蛋白水解酶（简称胶原酶，collagenase），是一种高度特异性作用于胶原组织螺旋结构的蛋白水解酶。胶原酶化学溶解术（collagenase chemonucleolysis， CCNL）是指将外源性胶原酶注射到病变的椎间盘内或突出物周围，使胶原分子解链变性，最终降解为相关氨基酸，被机体中和吸收，从而使突出物减小或消失，以减轻其对神经组织的压迫，达到缓解或消除患者临床症状的治疗方法。

1968年美国学者Sussman [1]使用胶原酶对椎间盘组织进行体外溶解试验及动物实验，首次证实了胶原酶是具有专一水解胶原蛋白的特异性溶解酶，提出可用特异性的胶原酶来治疗腰椎间盘突出症（lumbar intervertebral disc herniation，LIDH），1981年又发表了胶原酶治疗29例LIDH患者取得成功的报道[2]。我国最早于1972年由上海医药工业研究院开始进行对胶原酶的研究，1975年始朱克闻等[3]开始使用国产注射用胶原酶用于临床治疗LIDH，并于1982年报道了对252例CCNL的随访疗效，证实了其极为明显的疗效与安全性。……