X射线引导下硬膜外靶向阻滞联合针刀治疗腰椎间盘突出症研究  

Clinical study of targeted epidural space block combined with acupotomy in the treatment of lumbar disc herniation under X-ray guidance

作　　者：张嬴政 王亚东 邓小月 蔡璐[1] 王维珍 杨秋霞 孙亚芳 刘菲菲 Zhang Yingzheng;Wang Yadong;Deng Xiaoyue;Cai Lu;Wang Weizhen;Yang Qiuxia;Sun Yafang;Liu Feifei(Department of Pain,Jiangyin Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangyin 214400,China;Department of Imaging,Jiangyin Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangyin 214400,China;Health Management Center,Jiangyin Affiliated Hospital of Nanjing University of Chinese Medicine,Jiangyin 214400,China)

机构地区：[1]南京中医药大学江阴附属医院疼痛科,江阴214400 [2]南京中医药大学江阴附属医院影像科,江阴214400 [3]南京中医药大学江阴附属医院健康管理中心,江阴214400

出　　处：《中国医学装备》2025年第3期68-72,共5页China Medical Equipment

基　　金：江苏省卫生健康委科研项目(M202152)。

摘　　要：目的:探讨X射线影像监测下硬膜外前间隙靶向阻滞联合针刀松解治疗腰椎间盘突出症(LDH)的临床疗效,分析其操作安全性。方法:选取2022年1月至2023年9月南京中医药大学江阴附属医院疼痛科收治的60例LDH患者,按照随机数表法将其分为观察组和对照组,每组30例。观察组采用X射线影像监测下硬膜外前间隙靶向阻滞联合针刀松解术,对照组采用常规硬膜外阻滞,均治疗一次。比较两组患者治疗前及治疗后3、7和30d时疼痛视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评分,以及术后30d根据ODI评分评定疗效,同时对观察组患者的穿刺与针刀松解的安全距离进行分析。结果:观察组治疗有效率为96.67%,对照组治疗有效率为70%,两组比较差异具有统计学意义(x^(2)=7.680,P<0.05);治疗后3、7和30d时的两组疼痛VAS评分较治疗前均降低,且观察组(2.30±0.87)、(1.53±0.86)和(1.47±0.81)低于对照组(4.43±0.89)、(2.23±0.89)和(4.27±0.82),差异有统计学意义(t=9.374、3.098、13.306,P<0.05);治疗后3、7和30d时的两组ODI评分较治疗前均降低,且观察组低于对照组,差异有统计学意义(t=7.112、10.690、10.151,P<0.05);观察组30例患者中25例硬膜囊与患侧小关节内缘间隙>4.0mm,且均能安全靶向穿刺。结论:采用X射线影像监测下硬膜外前间隙靶向阻滞联合针刀松解治疗能有效改善LDH患者的疼痛症状和日常生活活动能力,其治疗安全有效。Objective:To explore the clinical efficacy of targeted epidural space block combined with acupotomy in the treatment for lumbar disc herniation(LDH)under the monitor of X-ray image,and to analyze the safety of its operation.Methods:A total of 60 LDH patients who admitted to Department of Pain,Jiangyin Affiliated Hospital of Nanjing University of Chinese Medicine from January 2022 to September 2023 were selected,and they were randomly divided into observation group and control group as random number table,with 30 cases in each group.The observation group adopted targeted epidural space block combined with acupotomy under monitor with X-ray for anterior epidural space,while the control group adopted conventionally epidural block,all of which were treated only once.The Visual Analogue Scale(VAS)scores and Oswestry Disability Index(ODI)scores of two groups th th th before treatment and at the 3rd day,7 day and 30 day after treatment were compared.At the 30 day after treatment,the curative effects of two groups were evaluated according to ODI scores,at the same time,the safe distance between puncture and acupotomy in patients of observation group was analyzed.Results:The effective rates of the treatment of observation group and control group were respectively 96.67%and 70%,and the difference of that between the two groups was statistically significant(x^(2)=7.680,P<0.05).th th The VAS scores of the two groups at the 3rd day,7 day and 30 day after treatment were lower than those before treatment,and the observation group(2.30±0.87),(1.53±0.86)and(1.47±0.81)were lower than the control group(4.43±0.89),(2.23±0.89)and(4.27±0.82),the difference was statistically significant(t=9.374,3.098,13.306,P<0.05).The ODI scores of the two groups were th th at the 3rd day,7 day and 30 day after treatment were lower than those before treatment,and the differences of them between two groups were statistically significant(t=7.112,10.690,10.151,P<0.05).In 30 patients of observation group,the gap between the dural sac and the inner e

关 键 词：腰椎间盘突出症(LDH) 硬膜外前间隙靶向阻滞 针刀 X射线引导 安全性分析 

分 类 号：R816.8[医药卫生—放射医学]