CT引导下经皮介入及康复一体化治疗腰椎间盘突出症  

CT-guided percutaneous intervention combined with rehabilitation integration treatment for lumbar disc herniation

作　　者：戴德纯[1] 童国海[2] 边联龙[3] 唐春林[1] 朱伟芳[1] 梅麟凤[1] 石长根[1] 姜浩[1] 杭方杰[1] 

机构地区：[1]昆山市中医医院,南京中医药大学附属昆山医院康复科,江苏省昆山市215300 [2]上海交通大学附属瑞金医院放射科,上海市200025 [3]昆山市中医医院,南京中医药大学附属昆山医院放射科,江苏省昆山市215300

出　　处：《中国组织工程研究》2013年第48期8449-8454,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:CT引导下经皮介入和传统特色康复技术皆为腰椎间盘突出症临床诊疗的经典方案,二者的糅合是否有助于患者功能恢复,取得较好的临床干预结局?目的:评估CT引导下经皮药物介入结合康复一体化治疗腰椎间盘突出症的临床疗效,探讨影响疗效的相关因素。方法:于2010年5月至2013年5月,对88例腰椎间盘突出症患者行CT引导下经皮药物介入结合康复一体化治疗。药物由复方倍他米松、丹参酮ⅡA磺酸钠、神经妥乐平、生理盐水和碘海醇等组成,康复综合治疗包括牵引、推拿、针灸、经皮神经电刺激和磁振热疗法。疗效评价采用Macnab标准和汉化Oswestry功能障碍指数(ODI)。并与先前报道的112例单纯CT引导药物介入治疗的临床疗效进行统计学比较。采用关联分析探讨年龄分组、病程分期、椎间盘突出节段分型等对疗效结局的影响。结果与结论:1年随访77例患者,其中优64例,良7例,可5例,差1例,结局优良率占92%。术后1个月、6个月和1年随访与治疗前比较,患者改良Oswestry功能障碍指数各条目及总分有逐渐降低的趋势,差异有显著性意义(P<0.01)。纳入患者未见严重并发症发生。药物介入结合康复组与单纯药物介入组相比结局优良率有提高的趋势,但差异尚无显著性意义(P>0.05)。与>45岁组比较,患者年龄≤45岁可取得较好的临床疗效,组间比较差异有显著性意义(P<0.01)。病程长短、椎间盘突出的形态、单节段和多节段突出与疗效结局尚无明确的关联性(P>0.05)。结果表明CT引导下经皮药物介入结合康复一体化治疗可有效缓解腰椎间盘突出症患者腰背痛及下肢放射痛症状,降低生活功能障碍程度。BACKGROUND： CT-guided percutaneous intervention and rehabilitation techniques are both classic programs for diagnosis and treatment of lumbar disc herniation. Is the combination of CT-guided percutaneous intervention and rehabilitation techniques preferentially used for treatment of lumbar disc herniation？ OBJECTIVE： To evaluate the curative effect of CT-guided interventional injection combined with rehabilitation integration treatment for lumbar disc herniation and to analyze prognostic factors.METHODS： Eighty-eight patients with lumbar disc herniation were subjected to CT-guided interventional injection combined with rehabilitation integration treatment from May 2010 to May 2013. Injection medicine consisted of betamethasone, tanshinone Ⅱ A sulfonate, neurotropin, normal saline and iohexol. Rehabilitation integration treatment included traction, manipulation, acupuncture, transcutaneous electrical nerve stimulation and thermal magnon. Macnab criteria and Chinese version of Oswestry low back pain disability questionnaire were used to assess the curative effects in comparison with the 112 patients receiving only CT-guided interventional injection that were reported previously. The prognostic factors, such as age, disease course time and herniation type of target segment were testified by correlation analysis. RESULTS AND CONCLUSION： Totally 77 patients were completely followed up for 1 year. There were excellent outcomes in 64 cases, while favorable outcomes in 7 cases, fair outcomes in 5 case, poor outcome in 1 case, with a better outcome rate of 92%.There was a significantly decreased trend in Oswestry disability Index scores at 1, 6, 12 months during the follow-ups（P 0.01）. No severe complications occurred in all the included patients. The curative effects were improved in term of better outcomes rate compared with the 112 patients receiving only CT-guided interventional injection, but there was no significant difference（P 0.05）. The young group（≤ 45 years） had better outcomes than th

关 键 词：骨关节植入物 骨与关节临床实践 CT引导经皮穿刺 腰椎间盘突出症 一体化治疗 汉化Oswestry功能障碍指数 

分 类 号：R318[医药卫生—生物医学工程]