肌骨超声引导下针刀松解不同点位治疗腰椎间盘突出症的临床观察  

Clinical observation on needle knife release at different sites in the treatment of lumbar disc herniation guided by musculoskeletal ultrasound

作　　者：聂思源 李远峰[2] 韩慧德 姜益常[2] 徐红 王凤玲 王浩 崔立建 NIE Siyuan;LI Yuanfeng;HAN Huide;JIANG Yichang;XU Hong;WANG Fengling;WANG Hao;CUI Lijian(The First Clinical Medical College,Heilongjiang University of Chinese Medicine,Heilongjiang Province,Harbin150040,China;Department of Orthopedics,the First Affiliated Hospital of Heilongjiang University of Chinese Medicine,Heilongjiang Province,Harbin150040,China;Department of Orthopedics,Heilongjiang Academy of Chinese Medicine,Heilongjiang Province,Harbin150036,China)

机构地区：[1]黑龙江中医药大学第一临床医学院,黑龙江哈尔滨150040 [2]黑龙江中医药大学附属第一医院骨伤科,黑龙江哈尔滨150040 [3]黑龙江省中医药科学院骨伤科,黑龙江哈尔滨150036

出　　处：《中国医药导报》2025年第8期139-144,共6页China Medical Herald

基　　金：黑龙江省卫生健康委员会科研课题(20232121020089)。

摘　　要：目的 比较肌骨超声引导下针刀松解不同点位治疗腰椎间盘突出症的临床效果。方法 选取2023年9月至2024年7月于黑龙江省中医医院骨伤科诊治的90例腰椎间盘突出症患者,根据随机数字表法分为对照组、椎间孔组和关节突关节组,每组各30例。三组均在肌骨超声引导下进行针刀操作,对照组选取腰臀部阳性反应点作为针刀治疗点,椎间孔组和关节突关节组在对照组的基础上分别对腰椎突出节段的椎间孔外口和关节突关节进行松解。每周1次,连续治疗3周。比较三组治疗前后腰椎活动度、腰痛和下肢放射痛视觉模拟评分法(VAS)评分、日本骨科协会(JOA)评分及临床疗效。结果 治疗后,三组腰椎活动度均大于治疗前,且椎间孔组、关节突关节组均大于对照组,关节突关节组大于椎间孔组(P<0.05)。治疗后,三组腰痛和下肢放射痛VAS评分均低于治疗前,且椎间孔组、关节突关节组腰痛VAS评分均低于对照组,椎间孔组下肢放射痛VAS评分均低于对照组、关节突关节组(P<0.05)。治疗后,三组JOA评分均高于治疗前,且椎间孔组、关节突关节组均高于对照组,关节突关节组高于椎间孔组(P<0.05)。关节突关节组临床疗效优于对照组(P<0.05)。结论 在肌骨超声引导下,不同点位的针刀松解均能有效改善患者的腰椎活动度、疼痛程度及腰椎功能,且同时松解腰臀部阳性反应点和关节突关节的综合效果更具优势。Objective To compare clinical effectiveness of needle knife release at different sites in the treatment of lumbar disc herniation guided by musculoskeletal ultrasound.Methods A total of 90 patients with lumbar disc herniation treated in Department of Orthopedics at Heilongjiang Provincial Traditional Chinese Medicine Hospital from September 2023 to July 2024 were selected and divided into the control group,the intervertebral foramen group,and the zygapophysial joint group by using a random number table method,with 30 patients in each group.All three groups underwent needle knife operation under musculoskeletal ultrasound guidance.The control group selected the positive reaction points of lumbar and gluteal regions as needle knife treatment points,the intervertebral foramen group and the zygapophysial joint group released external orifice of the intervertebral foramen and the zygapophysial joint of lumbar protrusion segment respectively on the basis of the control group.Once a week,continuous treatment for three weeks.Lumbar range of motion,visual analog scale(VAS)scores of lower back pain and lower limb radiating pain,Japanese Orthopaedic Association(JOA)score and clinical effectiveness among the three groups were compared.Results After treatment,lumbar range of motion in the three groups were greater than before treatment,the intervertebral foramen group and the zygapophysial joint group were greater than the control group, the zygapophysial joint group was greater than the intervertebral foramen group (P<0.05). After treatment, VAS scores of lower back pain and lower limb radiating pain in the three groups were lower than before treatment, VAS scores of lower back pain in the intervertebral foramen group and the zygapophysial joint group were lower than those in the control group, VAS scores of lower limb radiating pain in the intervertebral foramen group were lower than those in the control group and the zygapophysial joint group (P<0.05). After treatment, JOA scores in the three groups were higher than before

关 键 词：腰椎间盘突出症 肌骨超声 针刀 椎间孔外口 关节突关节 

分 类 号：R246[医药卫生—针灸推拿学]