经关节突滑膜和椎板肌肉附着点感受器通路给药治疗椎间盘突出性腰腿痛:1236例分析  

Injection administration into the synovium of the lumbar zygapophyseal joints and muscular attachment point of the neural scute through receptor-mediated pathway in 1 236 patients with discogenic low back pain

作　　者：章云海[1] 耿祝生[1] 雷玲[1] 徐志强[1] 

机构地区：[1]连云港市第一人民医院疼痛科,江苏省连云港市222002

出　　处：《中国组织工程研究与临床康复》2008年第42期8327-8330,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

基　　金：国家自然科学基金资助项目(30271260);江苏高校省级重点实验室第三批对外开放课题(K2093);江苏省科技厅指导计划课题(BS2002305);连云港市科技局课题(SH0408);连云港市科技局课题(SH0507)~~

摘　　要：背景:髓核中炎症递质诱导神经根炎症是产生腰腿痛主要因素。感受器通路系列研究发现,神经系统存在自身循环,经感受器通路给药有靶向给药的功效。目的:分析经腰椎关节突滑膜和椎板肌肉附着点给药治疗椎间盘突出性腰腿痛1236例治疗效果。设计、时间及地点:病例分析,于2002-03/2007-03在连云港市第一人民医院完成。对象:选择疼痛科就诊的椎间盘突出性腰腿痛患者1236例。男370例,女866例。年龄20～80岁。患者腰腿痛伴有腰椎间盘膨出、突出物小于椎管的1/3。方法:患者经腰椎间盘膨出、突出的椎关节突和椎板注射药物,药物配方:复方倍他米松(得宝松)5mg+左氧氟沙星0.1g+20g/L利多卡因5mL+生理盐水氯化钠至20mL+透明质酸钠(施沛特)20mg。1次/周,2,3次为1个疗程。1个月以内不要过度负重。主要观察指标:治疗效果和复发率。结果:1236例椎间盘突出性腰腿痛患者1个疗程临床治愈1142例(94%),好转89例(7.2%),无效5例(0.4%)。1年随访资料完善的322例,未复发250例(77.6%),复发72例(22.4%);2年随访资料完善的206例,未复发155例(75.2%),复发51例(24.8%);3年随访资料完善的91例,未复发74例(81.3%),复发17例(18.7%);4年随访资料完善的62例,未复发52例(83.8%),复发10例(16.2%);5年随访资料完善的32例,未复发27例(84.3%),复发5例(15.6%)。结论:经腰椎关节突滑膜和椎板肌肉附着点感受器通路给药治疗椎间盘突出性腰腿痛简单有效。BACKGROUND： Inflammatory mediators-induced neurodocitis in the nucleus pulposus is a main factor for bacldeg pain. Receptor pathway studies confirmed that the nervous system had self-circulation. Administration by receptors has the same effect as targeting drug delivery. OBJECTIVE： To evaluate the therapeutic efficacy of drug injection on synovium of lumbar zygapophyseal joints and muscular attachment point of neural scute in 1 236 patients with discogenic low back pain. DESIGN, TIME AND SETTING： The case analysis experiment was performed at the First People＇s Hospital from March 2002 to March 2007. PARTICIPANTS： 1 236 patients with discogenic low back pain were selected at the Department of Pain, including 370 males and 866 females, aged from 20 to 80 years. The patients accompanied with bulging of lumbar intervertebral disc and protrusions less than 1/3 vertebral canal, METHODS： Drugs were injected on bulges of lumbar intervertebral disc, protuberate zygapophysis and neural scute. General pharmaceutical formulation： Betamethason copound injection 5 mg＋ levofloxacin 0.1 g＋20 g/L lidocaine 5 mL＋sacine metered to 20 mL＋ sodium hyaluronate 20 mg. The administration was once a week and one course of treatment had three administrations. There was no overweight loading during one month. MAIN OUTCOME MEASURES： Therapeutic efficacy; relapse rate. RESULTS： In 1 236 patients with one course of treatment, there were healing in 1 142 cases （94%）, improvement in 89 cases （7.2%）, inefficacy in 5 cases （0.4%）. In 322 patients with one year consummate data, there were no relapse in 250 cases （77.6%）, relapse in 72 cases （22.4%）. In 206 patients with two year consummate data, there were no relapse in 155 cases （75.2%）, relapse in 51 cases （24.8%）. In 91 patients with three year consummate data, there were no relapse in 74 cases （81.3%）, relapse in 17 cases （18.7%）. In 62 patients with four year consummate data, there were no relapse in 52 cases （83.8%）, relapse in

关 键 词：腰腿痛 关节突 滑膜 椎板 组织构建 

分 类 号：R681[医药卫生—骨科学]