椎间盘源性腰痛的治疗方法选择及疗效评价  

Discogenic back pain treatment selection and curative effect evaluation

作　　者：胡永胜[1] 阿曼[1] 周刚[1] 田慧中[1] 郑君涛[1] 黄卫民[1] 刘伟[1] 

机构地区：[1]新疆医科大学第六附属医院脊柱外科,乌鲁木齐830002

出　　处：《中国矫形外科杂志》2013年第15期1497-1501,共5页Orthopedic Journal of China

摘　　要：[目的]探讨采用臭氧髓核消融术、腰椎融合术二种方法治疗椎间盘源性腰痛的临床疗效并且分析原因。[方法]回顾性分析2007年8月～2011年3月临床诊断椎间盘源性腰痛共86例,其中男性51例,女性35例;平均年龄42岁(22～58岁),病程平均9.3个月(6周～8年)。病例均为单节段:L3、4椎间盘6例,L4、5椎间盘42例,L5S1椎间盘38例。治疗分为二组:A组使用臭氧髓核消融术49例。B组采用腰椎融合术37例。二组患者年龄、性别、病程、术前疼痛视觉模拟评分(visual analogue scale,VAS)和功能障碍评分(Oswestry disability index,ODI)差异无统计学意义,术后比较疼痛视觉模拟评分及功能障碍评分变化和按改良MacNab功能评价标准评价患者对治疗主观满意度。[结果]全部病例均成功完成手术;无神经损伤、大出血、死亡病例。术后随防18～36个月,平均25.1个月。二组病例术后VAS和ODI评分进行对照:二种治疗方法术后VAS评分依次降低为(3.8±1.2),(6.5±1.5);(t=9.27,P=0.000);A和B组之间有统计学差异(P<0.05),术后ODI评分依次降低为(12.4±3.6),(27.5±4.8);(t=16.68,P=0.000);A和B组之间有统计学差异(P<0.05)。患者满意度:A组73.5%,B组91.2%。[结论]二种治疗方法对于椎间盘源性腰痛均为有效治疗。腰椎融合术与臭氧髓核消融术相比较,前者在改善患者疼痛和功能方面有明显的优势。但手术创伤大,治疗过程复杂,应做为本病终末治疗手段。而臭氧髓核消融术属微创治疗,简单安全,可作为此病的初期或中期治疗。[ Objective] To investigate the use of ozone ablation of nucleus pulposus, lumbar fusion in the treatment of discogenic low back pain and analyze the curative effects and reasons. [ Methods] A retrospective analysis on lumbar discogenic low back pain in 86 cases was made from August 2007 to March 2011, including male in 51 cases, female in 35 cases; L3,4 intervetebral disc in 6 cases, L4.5 intervertebral disc in 42 cases; L5 S1 intervertebral disc in 38 cases. All patients were divided into ozone nucleus pulposus ablation group with 49 cases, and lumbar fusion group with 37 cases. The age, sex, duration of disease, preoperative pain visual analogue score （VAS）, and Oswestry disability index （ODI） had no significant difference before operation. The postoperative pain visual analogue score, dysfunction score change and modified MacNab fuction score were compared between 2 groups after operation to evaluate the satisfaction rate. [ Results ] All patients completed the operation success- fully, without neurological infury, over bleeding, death case. All patients were followed up for 18 -36 months （mean, 25.1 months） . VAS in 2 groups reduced to （ 3.8 ± 1.2 ）, （ 6. 5 ± 1.5 ）, （ t = 9. 27, P = 0. 000）, with significant difference （ P 〈 0. 05） . ODI in 2 groups reduced to （ 12.4 ±3.6） , （27.5 ±4. 8） , （t = 16. 68, P =0. 000） , with significant difference （P 〈 0. 05 ） . Patients satisfaction rates were 73.5% in group A and 91.2% in group B. [ Conclusion] Two treatments for discogenie low back pain are effective. Lumbar fusion treatment has advantages of improvement of pain and function, and disadvanta- ges of trauma, complex procedure. It should be the terminal treatment. Ozone nucleus pulposus ablation is minimally invasive, simple and safe, can be used as the early and medium- term treatment.

关 键 词：椎间盘源性腰痛 臭氧髓核消融术 腰椎融合术 

分 类 号：R687.3[医药卫生—骨科学]