摘要
目的:探讨经皮椎间孔镜联合针刀治疗对腰椎间盘突出症(lumbar disc herniation,LDH)病人步行稳定性的影响及相关机制。方法:选择2020年9月至2021年9月期间就诊于解放军总医院第六医学中心中医医学部骨伤科、康复医学科、针灸科的104名LDH病人,通过计算机随机分为研究组(n=52)和对照组(n=52)。研究组接受腰椎经皮穿刺椎间孔镜(percutaneous transforaminal endoscopic discectomy,PTED)手术治疗,在突出间盘处理完成后给予针刀治疗,术后48 h开始进行2周的腰椎康复。对照组接受相同操作的PTED手术治疗,但不给予针刀治疗,术后48 h同样开始进行2周的腰椎康复。在术前基线和术后6个月利用步态分析系统对病人的步行稳定性指标—步行绝对对称指数(absolute symmetry index,ASI)进行评估,同时收集MRI显影下椎旁多裂肌(multifidus muscle,MM)的脂肪浸润横断面(cross-sectional area,CSA)以及两组病人的日本骨科协会(Japanese orthopedic association,JOA)评分。结果:治疗后,研究组病人的步速、步幅、髋屈曲均值角度、膝屈曲均值角度的ASI均显著降低;对照组病人的步幅、髋屈曲均值角度的ASI无显著变化。术前两组病人的JOA评分无明显差异,术后6个月,两组病人的JOA评分均显著改善。研究组JOA总分及其中的主观症状、日常生活活动能力(activities of daily living,ADL)受限度均显著优于对照组。在L4~5和L3~S1的总节段,研究组的MM脂肪浸润CSA明显减少。结论:PTED联合针刀治疗能够积极影响LDH病人的整体活动能力和步行稳定性,其机制可能是通过改善LDH病人特定节段的椎旁肌结构实现的。
Objective:To evaluate the effects of percutaneous transforaminal endoscopic discectomy(PTED)combined with acupotomy on the walk stability of the patients with lumbar disc herniation and related mechanism.Methods:From September 2020 to September 2021,104 patients with lumbar disc herniation(LDH)in the department of Orthopedics,Rehabilitation Medicine and Acupuncture of Traditional Chinese Medicine Unit of The Six Medical Center of Chinese PLA General Hospital were included in the study and randomly divided into 2 groups to receive either PTED combined with acupotomy and exercise rehabilitation(study group,n=52)or PTED combined with exercise rehabilitation(control group,n=52).Walk stability indexs absolute symmetry index(ASI),Japanese orthopedic association(JOA)scores and cross-sectional area(CSA)of fatty infiltration in multifidus muscle(MM)under MRI imaging were recorded before and 6 months after surgery.Results:Before and after treatment,the ASI of the step speed,stride length,mean angle of hip flexion and knee flexion in the study group were significantly decreased,and there were no significant difference in ASI of stride length and mean angle of hip flexion compared with the control group.Before surgery,there was no significant difference in JOA between the two groups.Six months after surgery,JOA scores in both groups were significantly improved,and JOA scores in the study group were significantly lower than those in the control group,Meanwhile,the scores of JOA,subjective symptoms and activities of daily living(ADL)limit in JOA of the study group were significantly lower than those in the control group.At L4-5 and L3-S1,CSA of fat infiltration in MM in the study group was significantly decreased.Conclusion:For patients with LDH,the walking stability and overall mobility can be improved by PTED combined with acupotomy,which may be achieved by improving the paravertebral muscle structure of specific segments.
作者
钟毓贤
丁宇
付本升
马广昊
崔洪鹏
刘倩
潘灵芝
陈婷婷
徐航晨
焦浩洋
关玲
ZHONG Yuxian;DING Yu;FU Bensheng;MA Guanghao;CUI Hongpeng;LIU Qian;PAN Lingzhi;CHEN Tingting;XU Hangchen;JIAO Haoyang;GUAN Ling(Medical School of Chinese PLA,Beijing 100853,China;Department of Rehabilitation Medicine,The Six Medical Center of Chinese PLA General Hospital,Beijing 100048,China;Orthopedics of Traditional Chinese Medicine Unit,The Six Medical Center of Chinese PLA General Hospital,Beijing 100048,China;Acupuncture of Traditional Chinese Medicine Unit,The Six Medical Center of Chinese PLA General Hospital,Beijing 100853,China)
出处
《中国疼痛医学杂志》
CAS
CSCD
北大核心
2023年第4期274-280,共7页
Chinese Journal of Pain Medicine
基金
军队中医药服务能力培育与提升专项计划重点课题(2021ZY006,2021ZY007)
解放军总医院第六医学中心创新培育基金(CXPY201917)。
关键词
腰椎
步态
康复
多裂肌
lumbar
gait
rehabilitation
multifidus muscle
