两种不同剂量硬膜外类固醇注射治疗腰椎间盘突出症相关神经根病变的疗效比较  

Comparison ofthe effects of two different doses of epidural steroid injection in the treatment of lumbar intervertebral disc herniation-related radiculopathy

作　　者：杨笑宇 吴献民 刘祥飞 杜暠 刘仲祥 杨国庆 YANG Xiao-yu;WU Xian-min;LIU Xiang-fei;DU Hao;LIU Zhong-xiang;YANG Guo-qing(Department of Orthopedics,Shanghai Zhongye Hospital,Shanghai,200941,China)

机构地区：[1]上海市中冶医院骨科

出　　处：《颈腰痛杂志》2020年第1期29-32,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨两种不同剂量硬膜外类固醇注射(epidural steroid injection,ESI)治疗腰椎间盘突出症相关神经根病变的疗效。方法选择2016年1月~2018年12月在本院就诊的92例LDH患者,采用随机数字表法分为A组和B组各46例。A组给予X线引导下40 mg甲基强的松龙ESI,B组为80 mg。观察2组注射前、注射后1 h、3周、12周时的疼痛数字评分(NRS),以及注射前、注射后3周、12周的Oswestry指数(ODI)和SF-36量表评分。结果2组患者注射后1 h、3周、12周的NRS评分与注射前相比较均显著降低(P<0.05),2组间差异无统计学意义(P>0.05)。注射后3周、12周时,2组患者ODI均较术前显著降低(P<0.05),2组间差异均无统计学意义(P>0.05)。与注射前相比较,2组患者注射后3周、12周时的生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康等评分均显著升高(P<0.05),但组间差异均无统计学意义(P>0.05)。结论不同剂量甲基强的松龙之间临床效果无显著差异,考虑到高剂量甲基强的松龙不良反应增加的风险,建议临床应尽量采用40 mg的低剂量进行治疗。Objective To investigate the efficacy of two different doses of epidural steroid injection(ESI)in the treatment of lumbar disc herniation(LDH)associated radiculopathy.Methods Ninety-two patients with LDH who were treated in our hospital from January 2016 to December 2018 were selected in the study,and the patients were divided into group A and group B by random number table,with 46 cases in each group.The group A was given 40 mg methylprednisolone ESI under X-ray guidance,and the group B was given 80 mg.The pain score(NRS),Oswestry index(ODI)and SF-36 scale were observed.Results The NRS scores of the two groups at 1 hour,3 and 12 weeks after injection were significantly lower than before injection(P<0.05),and there was no significant difference between the two groups(P>0.05).The ODI was significantly lower in the two groups at 3 weeks and 12 weeks after injection than before injection(P<0.05),and there was no significant difference between the two groups(P>0.05).The scores of physiological function,physiological role,physical pain,general health status,energy,social function,emotional function and mental health of the two groups were significantly higher than before injection(P<0.05),and there were no significant differences between the two groups(P>0.05).Conclusion There is no significant difference in clinical effect between different doses of methylprednisolone.Considering the increased risk of adverse reactions of high doses of methylprednisolone,it is suggested that low doses of 40 mg should be used as far as possible in clinical treatment.

关 键 词：腰椎间盘突出症 疼痛 硬膜外类固醇注射 经椎间孔途径 

分 类 号：R681.53[医药卫生—骨科学]