摘要
目的:对比观察硬膜外隙注药与腰椎定点牵压疗法及其联合应用治疗腰椎间盘突出症的疗效。方法:①选择2004-01/2006-01解放军总医院康复医学科门诊诊治的腰椎间盘突出症患者180例,男125例,女55例,年龄20～65岁。患者对治疗方案知情同意。按随机数字表法将患者分为3组:硬膜外隙注药组、腰椎定点牵压疗法组、联合治疗组,每组60例。硬膜外隙注药组:骶管注射利多卡因注射液、胞二磷胆碱、维生素B12、地塞米松混合液,每5d注射1次,共4次。腰椎定点牵压疗法组:采用胸带与下肢固定带牵引,待牵引床启动逐渐使患者腰脊柱拉伸时,术者双手拇指关节突关节连线,由上腰段向腰骶段滑行推压,当拇指推压到病变间隙时,牵引力须达到患者体质量1.5倍左右,迅速向脊柱前方施压。共2次。联合治疗组为两种疗法联合应用。每2次硬膜外隙注药后施行腰椎定点牵压疗法疗法1次,共2次。②于治疗前和治疗后3,6个月采用疼痛强度评分评估疼痛程度(0～10分,0分为无痛,10分为最痛),治疗前和治疗后3个月观察临床体征和评估疗效,疗效评估依据胡有谷的腰椎间盘突出症和国家中医药管理局(1994年)制定的中医病症诊断疗效标准。③计量和计数资料差异比较分别采用t检验和χ2检验。结果:腰椎间盘突出症患者180例均进入结果分析。①疼痛强度变化:治疗后3个月3组疼痛强度评分均较治疗前降低,其中联合治疗组与治疗前比较,差异明显(χ2=2.13,P<0.01)。治疗后6个月,各组病例的疼痛症状大多数获得控制,其中联合治疗组疼痛强度评分与治疗前比较,差异明显(χ2=4.03,P<0.01),联合治疗组和硬膜外隙注药组疼痛强度评分明显低于腰椎定点牵压疗法组(χ2=5.62,6.16,P<0.05)。②临床体征变化:各组治疗后3个月4项体征均较治疗前改善,其中联合治疗组直腿抬高试验阳性患者数明显少于硬膜外隙注药组和腰椎定点牵压疗法组(7,19,14例,χ2=9.24,9.14,P<0.01)。③疗效:联合治疗组治疗有效率明显高于其他硬膜外隙注药组和腰椎定点牵压疗法组[100%(60/60),88%(53/60),92%(55/60),χ2=6.26,6.04,P<0.01],而其他2组间比较,差异不明显(χ2=8.63,P>0.05)。结论:硬脊膜外注药及腰椎定点牵压疗法均是治疗腰椎间盘突出症的有效疗法,联合应用疗效更好。
AIM： To compare the curative effects of extradural injection （EI） and traction and back stretch press manipulation of lumbar spine （TBSPM.） and the integrated therapy of them on treating lubar intervertebral disc protrusion, METHODS： （1） 180 patients with lubar intervertebral disc protrusion diagnosed and treated in the Department of Rehabilitation Medicine, General Hospital of Chinese PLA were selected between January 2004 and January 2006 including 125 males and 55 females aged 20-65 years. All the patients were informed and agreed the treating plan. They were randomly divided into three groups： EI group, TBSPM group and integrated group with 60 patients in each group. Patients in the EI group received epidural injection of mixed liquor of lidocaine, citicoline, vitamin B12 and dexamethasone once every 5 days for totally 4 times. The traction and back stretch press manipulation of lumbar spine was adopted to treat the patients in the TBSPM group for total two times. The traction was performed by pectoral girdle and compression band of the lower limbs, when the traction table was switched on to pull the lumbar spine of the patient, the operator pushed the upper lumbar segment to lumbar sacral segment along the articulatione zygapophysiales with the thumbs of two hand; when pushing to the pathological crevice, the traction power should be adjusted to 1.5 times of the body mass of the patients to push the front of the spine. Patients in the integrated group received integrated treatment of both former groups. The traction and back stretch press manipulation of lumbar spine treatment was performed once after every two times of injection for twice. （2）The pain scores （0-10 marks, 0 meant painless, and 10 the most painful） of 3 and 6 months before and after the treatment were evaluated, clinical presentations and the curative effects of 3 months before and after treatment were observed. The curative effect evaluation was accorded to the criteria for the lubar intervertebral disc protrusion formulated by Hu You-gu and the Diagnostic and Therapeutic Effect Cnteria of Traditional Chinese Medicine Syndromes by State Administration of Traditional Chinese Medicine （1994）. Measure and count data were compared by t test and Chi-square test. RESULTS： All 180 patients were involved in the result analysis. （1）Pain degree changes： Three months after treatment, the scores of pain evaluation in three groups were reduced compared with those before treatment, and that in the integrated group was more obvious （χ^2 =2.13, P 〈 0.01）. Six months after treatment, the pain symptoms in most patients were controlled, especially of the integrated group, which was greatly different from that before treatment （χ^2 =4.03 P 〈 0.01）. The scores of the integrated group and EI group were significant lower than the TBSPM group （χ^2 =5.62, 6.16, P 〈 0.05）. （2）Clinical signs changes： Four signs of each group were obviously ameliorated after treatment, especially the positive rate in straight-leg raising test, in which the number of the integrated group was smaller than the EI group as well as TBSPM group （7, 19 and 14 cases, χ^2 =9.24, 9.14, P 〈 0.01）. （3）Effective rate： The rate of the integrated group was significantly higher than the EI group and TBSPM group [100% （60/60）, 88% （53/60）, 92% （55/60）, χ^2 =6.26, 6.04, P 〈 0.01], while there was no obvious difference between EI group and TBSPM group （χ^2 =8.63, P 〉 0.05）. CONCLUSION： Both of extradural injection and traction and back stretch press manipulation of lumbar spine treatment have good effects on lubar intervertebral disc protrusion, while the curative effect of the integrated treatment is the best.
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第30期5892-5895,共4页
Journal of Clinical Rehabilitative Tissue Engineering Research
