腰椎间盘突出症所致坐骨神经痛的定量感觉分析  

Quantitative sensory analysis of sciatica caused by lumbar disc herniation

作　　者：肖守允 贾瑞钢[1] 张俊[1] 魏建军[1] 李志伟[2] 

机构地区：[1]南京明基医院南京医科大学附属医院骨科,江苏南京210019 [2]江苏省中医院骨科,江苏南京210029

出　　处：《中国临床研究》2016年第4期472-475,共4页Chinese Journal of Clinical Research

基　　金：江苏省第十一批高层次人才培养计划项目(WSW-010)

摘　　要：目的探讨腰椎间盘突出症所致坐骨神经痛定量感觉检查的相关特点,以及定量感觉分析在腰椎间盘突出症治疗方法的选择和预后判断中的作用。方法选取2013年10月至2014年10月在南京明基医院和江苏省中医院因腰椎间盘突出症所致坐骨神经痛就诊的70例患者,按随机数字表法分为保守组与手术组,每组35例,分别给予药物保守治疗和髓核摘除术手术治疗。于治疗后对所有患者采用类似极限法定量感觉检测小腿外侧部、足背外缘部皮肤的温度感觉、外踝部的振动感觉,神经电生理检测病侧H反射和胫神经的感觉神经传导速度,视觉类比法评价进行坐骨神经疼痛评分,分析其变化及差异。并根据定量感觉检查结果,将70例患者按感觉异常的轻(Ⅰ组)、中(Ⅱ组)、重(Ⅲ组)分为三个组,分析三组腰椎间盘突出度与治疗前后疼痛评分、感觉神经传导速度的关系。结果治疗后20 d评价,保守组临床治疗有效率(80.0%)与手术组(85.7%)比较差异无统计学意义(P>0.05)。治疗后20 d评价,保守组(包括病侧和健侧)与手术组小腿外缘的热觉、热痛觉和冷痛觉比较,足背的热觉、热痛觉比较,以及外踝部的振动觉比较,差异均有统计学意义(P均<0.05)。治疗前Ⅰ、Ⅱ、Ⅲ组患者的疼痛评分相近(P>0.05),治疗后三组疼痛评分均较治疗前明显降低(P<0.05或P<0.01);按Ⅰ、Ⅱ、Ⅲ组顺序,腰椎间盘突出度依次加大(P<0.01),疼痛评分随腰椎间盘突出度的递增而递升(P<0.01),即Ⅰ组疼痛改善最佳,Ⅲ组疼痛改善最小。感觉神经传导速度按Ⅰ、Ⅱ、Ⅲ组顺序随腰椎间盘突出度的递增而递降(P<0.05)。结论坐骨神经痛定量感觉检查是否有异常,可能作为腰椎间盘突出症治疗方法的选择和预后判断的一种指标。Objective To investigate the relevant characteristics of the quantitative sensory test for sciatica caused by lumbar disc herniation and its effect in the selection of treatment method and prognosis judgment for lumbar disc herniation.Methods Seventy patients with sciatica caused by lumbar disc herniation who visited Nanjing Ben Q Hospital and Jiangsu Province Hospital of Traditional Chinese Medicine from October 2013 to October 2014 were selected,and the patients were divided into two groups according to random number table method（ n = 35 each） ： conservation group（ conservative treatment with drugs） and surgery group（ excision of nucleus pulposus）. The temperature sensation of skin of the lateral lower legs and edges of instep（ quantitative sensory test with similar limit method）,the vibration sense of lateral malleolus area,H reflex of sick side and the sensory nerves conduction velocity（ SCV） of tibial nerve（ with nerve electrophysiology examination）,the sciatica scoring（ visual analogue method） after treatment were measured in all patients,and their changes and differences were analyzed. The patients were divided into three groups according to the degree of abnormal sensation： mild（ groupⅠ）,moderate（ group Ⅱ） and severe（ group Ⅲ）,and the association of protrusion degree of lumbar intervertebral disc with pain scores before and after treatment and SCV was analyzed. Results Twenty days after treatment,there was no significant difference in effective rate of clinic therapy between conservation group and surgery group（ 80. 0% vs 85. 7%,P 〉 0. 05）. There were significant differences in the thermal sensation,thermal pain sensation and cryalgesia sensation of out edges of the lower legs between conservation group（ sick side and healthy side） and surgery group,and there were also significant differences in the thermal sensation and thermal pain sensation of instep and the vibration sense of lateral malleolus area between two groups（ all P 〈 0. 05）. Th

关 键 词：腰椎间盘突出症 坐骨神经痛 定量感觉分析 手术治疗 保守治疗 

分 类 号：R681.53[医药卫生—骨科学]