臭氧椎旁注射结合功能锻炼治疗老年退变性腰椎滑脱症临床观察  

CLINICAL OBSERVATION ON LUMBAR PARAVERTEBRAL INJECTION OF OXYGENOZONE COMBINED WITH FUNCTIONAL EXERCISE IN THE TREATMENT OF LUMBOCRURAL PAIN WITH DEGENERATIVE LUMBAR SPONDYLOLISTHESIS IN OLD PEOPLE

作　　者：李娟红[1] 李桂英[2] 程斌[1] 朱一英[1] 

机构地区：[1]北京老年医院麻醉疼痛科,北京100095 [2]北京老年医院放射科,北京100095

出　　处：《中国疼痛医学杂志》2013年第8期463-468,共6页Chinese Journal of Pain Medicine

摘　　要：目的:探讨臭氧椎旁注射结合腰椎功能锻炼治疗老年退变性腰椎滑脱症临床效果。方法:选取2010年3月至2011年5月期间老年退变性腰椎滑脱症病例77例,采用数字表法随机分为椎旁注射结合腰椎功能锻炼组(简称局麻组)、臭氧椎旁注射结合腰椎功能锻炼组(简称臭氧组)和单纯腰椎功能锻炼组(简称对照组)。3组都口服甲钴胺片1个月,每日3次,每次0.5 mg,均行屈髋屈膝抱滚法腰椎功能锻炼。局麻组在上述治疗方法同期行患侧椎旁阻滞,1次/1周,治疗4～6次;臭氧组在行患侧椎旁阻滞同时同部位注射臭氧,1次/1周,治疗4～6次。采用腰痛视觉模拟评分(visualanalogue scale,VAS)和下肢痛VAS评分;采用腰椎JOA评分(29分法)和止痛药服用期的天数评定临床症状改善情况。结果:68例病例获得完整随访,均随访1年。在治疗后1周和1个月,臭氧组患者疼痛评分明显低于对照组和局麻组,差异有统计学意义(P<0.05);在治疗后1周、1个月,局麻组患者疼痛评分与对照组相比无统计学差异;在治疗后1年,臭氧组患者疼痛评分明显低于对照组和局麻组,差异有统计学意义(P<0.05);3组治疗后1年与治疗前比较,差异有统计学意义(P<0.05),提示3组在改善总体疼痛病情方面均有疗效(P<0.05)。腰椎JOA评分结果显示,臭氧组在痊愈率和良好率方面(即总优良率)高与局麻组和对照组,差异有统计学意义(P<0.05),提示臭氧组不仅在缓解疼痛,而且在改善腰腿功能及日常活动方面更具优势。臭氧组止痛药平均用药时间5.23±1.78 d,低于局麻组的13.68±5.18 d和对照组的18.76±7.57 d,差异有统计学意义(P<0.05),提示臭氧椎旁注射在老年退变性腰椎滑脱症临床治疗中能有效降低止痛药的服用量,从而减少止痛药长期服用的不良反应。结论:臭氧椎旁注射结合腰椎功能锻炼治疗老年退变性腰椎滑脱症安全有效,值得临床推广。Objective： To assess the clinical effects of treating elderly degenerative lumbar spondylolisthesis suffering from lumbocrural pain by lumbar paravertebral injection of oxygen-ozone combined with lumbar functional exercise. Methods： A prospective, randomized, controlled clinical trial was carried on 77 elderly patients suffering from lumbocrural pain caused by degenerative lumbar spondylolisthesis during Mar 2010 to May 2011. All patients were divided with the random number table method into three groups, lumbar paravertebral injection of lidocaine combined with lumbar functional exercise group （local block group）, lumbar paravertebral injection of oxygen-ozone combined with lumbar functional exercise group （ozone group）, and single lumbar functional exercise group （control group）. All groups received oral mecobalamin for 1 month, three times a day with 0.5 mg each time and performed lumbar functional exercise of rollingand rotating maneuvers with hip and knee flexion. The local block group also received lumbar paravertebral injection of 0.5% lidocaine at the same period for 4 to 6 times （once a week）. The ozone group received lumbar paravertebral injection of 0.5% lidocaine and oxygen-ozone at the same period for 4 to 6 times （once a week）. The improvement of clinical symptoms were assessed with the visual analogue scale （VAS） score for waist pain, the lower limb pain VAS score and the lumbar JOA score （29 points method）. Results：A total of 68 patients completed the full 1-year follow-up. The VAS scores for ozone group were significantly lower than that for control group and local block group at 1 week and 1 month after treatment （P 〈 0.05）. There was no significant difference in VAS scores at 1 week and 1 month between local block group and control group （P 〉 0.05）. The VAS scores for ozone group were significantly lower than that for control group and local block group at 1 year after treatment, the differences were statistically significant （P 〈 0.05）. For t

关 键 词：腰腿痛 腰椎滑脱症 老年人 椎旁注射 臭氧治疗 

分 类 号：R681.5[医药卫生—骨科学]