腰椎间盘激光修复术治疗根性坐骨神经痛的有效性和安全性  

Efficacy and safety of modified percutaneous laser disc decompression for radiculopathy from lumbar disc herniation

作　　者：吴玮[1] 奥列嘎.瓦西里耶夫娜 陈雪青[1] 叶乐[1] 朱玫娟[1] 俞晓杰[1] 王祥瑞[1] 

机构地区：[1]上海交通大学医学院附属仁济医院麻醉科,上海200127 [2]俄远东州立中心医院神经外科

出　　处：《上海医学》2016年第6期340-344,共5页Shanghai Medical Journal

摘　　要：目的比较椎间盘激光修复术与硬脊膜外腔激素注射(ESI)治疗腰椎间盘突出引发根性坐骨神经痛的疗效。方法将94例患者按1∶1随机分入椎间盘激光修复术组(激光组)和ESI组,每组47例。主要评估指标包括腰痛ODI(the oswestry disability index)评分和疼痛数字模拟评分(NRS评分)。结果在随访8周时,两组的ODI评分、NRS评分均显著低于同组基线值(P值均<0.05),且激光组ODI评分的下降程度较ESI组更为显著(校正后两组差异为-2.83,95%CI为-5.48^-0.18,P=0.04),但两组间NRS评分下降程度的差异无统计学意义(P>0.05)。在随访52周时,两组的ODI评分、NRS评分均显著低于同组基线值(P值均<0.05),且激光组ODI评分(校正后两组差异为-8.45,95%CI为-12.23^-4.66,P<0.01)和NRS评分(校正后两组差异为-0.70,95%CI为-1.26^-0.14,P=0.02)的下降程度均较ESI组更加显著。两组间在随访8和52周时总体康复率的差异均无统计学意义(P值均>0.05)。两组患者均无严重不良事件发生。结论椎间盘激光修复术治疗根性坐骨神经痛患者的疗效较ESI治疗更佳,但本研究结果的推广存在一定局限性。Objective To compare the curative effects between modified percutaneous laser disc decompression （MPLDD） and epidural steroids injection （ESI） on sciatica caused by lumbar disc herniation. Methods A total of 94 patients were randomly assigned to MPLDD group and ESI group （n = 47）. The clinical outcome was assessed primarily by the oswestry disability index （ODI） and numerical rating scale （NRS）, secondarily by 7-point Likert scale, body pain and physical function scores on the 36-1tern Short Form Health Survey, and the Brief Pain Inventory interference scaLe. Results Both ODI and NRS scores at 8 and 52 weeks after treatment were significantly lower than baselines in two groups （both P〈0. 05）. The MPLDD group showed an adjusted mean - 2.83-point greater improvement in ODI scores at 8 weeks after treatment （95% CI = - 5.48 to -0.18, P = 0.04） than the ESI group, but no significant difference was found in NRS scores between two groups （P〉0. 05）. The MPLDD group showed an adjusted mean -8. 45-point greater improvement in ODI scores （95 % OI ： - 12.23 to - 4.66, P〈. 01） and an adjusted mean - 0.70-point greater improvement in NRS scores （95% CI： - 1.26 to -0.14, P = 0.02） than the ESI group at 52 weeks after treatment. There was no significant difference in the overall recovery ratebetween groups either 8 weeks or 52 weeks postoperatively, No severe adverse events occurred. Conclusion The curative effect of MPLDD is better than ESI for radiculopathy resulted from herniated lumbar disc, but the application is limited. （Shanghai Med J, 2016, 39= 340-344）

关 键 词：椎间盘突出 激光 硬脊膜外腔激素注射 坐骨神经痛 

分 类 号：R745[医药卫生—神经病学与精神病学]