硬膜外粘连松解术治疗腰椎间盘突出症的疗效分析  

EFFICACY OF EPIDURAL NEUROPLASTY FOR THE TREATMENT OF HERNIATED LUMBAR DISC: A CONTROLLED CLINICAL TRIAL

作　　者：李晓勤[1] 袁宏杰[1,2] 安政庄 王群 顾楠[1] 吕岩[1] LI Xiao-Qing;YUAN Hong-Jie;AN Zheng-Zhuang;WANG Qun;GU Nan;LVYan(Department of Pain Medicine,Xijing Hospital,the Fourth Military Medical University,Xi＇an 710032,China;Department of Pain Medicine,Nantong Hospital of Traditional Chinese Medicine,Nantong 226001,China;Depart-ment of Pain Medicine,Shaanxi University of Traditional Chinese Medicine Hospital,Xianyang 712000,China)

机构地区：[1]第四军医大学西京医院疼痛科,西安710032 [2]南通市中医院疼痛科,南通226001 [3]陕西中医药大学附属医院疼痛科,咸阳712000

出　　处：《中国疼痛医学杂志》2018年第6期429-434,共6页Chinese Journal of Pain Medicine

基　　金：国家自然科学基金(31530090;81471139)

摘　　要：目的:比较硬膜外粘连松解术(epidural neuroplasty,ENP)和经椎间孔硬膜外注射(transforaminal epidural steroid injection,TFSI)治疗腰椎间盘突出症(herniated lumbar disc,HLD)的疗效。方法:试验共纳入78名病人,按照病人意愿进行分组,试验组接受ENP治疗(ENP组,n=27),对照组接受TFSI治疗(TFSI组,n=51)。两组病人术前、术后1月、3月、6月分别评估视觉模拟评分(visual analogue scale,VAS)和Oswestry功能障碍指数(oswestry disability index,ODI)。结果:治疗前两组病人的VAS和ODI评分没有明显的差异。治疗后1个月、3个月、6个月两组病人均较治疗前显著改善(P<0.001)。与TFSI组比较,ENP组术后3月和6月VAS评分显著下降(P<0.05);ENP组术后1月、3月、6月的ODI评分均显著低于TFSI组(P<0.05)。ENP组术后6月总体有效率高于TFSI组,有显著统计学差异(P<0.05)。结论:ENP和TFSI均能有效改善HLD病人的疼痛和功能,且ENP的疗效优于TFSI。Objectives： The aim of this clinic trial is to compare the effect of epidural neuroplasty （ENP） over transforaminal steroid epidural injection （TFSI） for the treatment of herniated lumbar disc （HLD）. Method： Seventy-eight HLD patients were enrolled and assigned into two groups. The ENP group received ENP treatment （n = 27） and the TFSI group underwent TFSI treatment （n = 51）. Visual analogue scale （VAS） and oswestry disability index （ODI） were recorded at baseline, 1 month 3 months and 6 months after treat- ments. Results： Compared with the baseline level the VAS and ODI scores in both ENP and TFSI groups were significantly improved at 1,3, and 6 months after treatments. The VAS scores of ENP group were significantly lower than those of TFSI group at 3 months and 6 months follow-up. The ODI scores of ENP group were also significantly reduced compared with the TFSI group, at 1 month, 3 months and 6 months follow-up. The effec- tive rate in the ENP group was superior to those in the TFSI group. Conclusions： Both ENP and TFSI treat- ments were effective for the treatment of HLD. ENP treatment could produce superior effect over TFSI in terms of pain reduction and functional improvement.

关 键 词：腰椎间盘突出症 经椎间孔硬膜外注射 硬膜外粘连松解术 激素 

分 类 号：R687.3[医药卫生—骨科学]