【摘要】：目的：近年來椎間盤源性腰痛越來越被臨床重視,它是所有不以神經(jīng)組織受壓為主要表現(xiàn)的腰椎間盤退行性疾病,本病多起病緩慢,并且緩解與復(fù)發(fā)遷延不斷,是極為棘手的疾病之一。椎間盤源性下腰痛目前主要有保守治療、微創(chuàng)治療和開放手術(shù)三種方法。由于開放手術(shù)治療的有創(chuàng)性、風(fēng)險(xiǎn)性、治療費(fèi)用昂貴,大部分患者無法接受,所以保守治療和微創(chuàng)治療則成為了大多數(shù)患者的選擇。本文通過探討腰椎牽引結(jié)合射頻熱凝術(shù)治療椎間盤源性腰痛的初步療效及其作用機(jī)制,從而為治療椎間盤源性腰痛提供安全可行的康復(fù)方案。方法：將中國(guó)人民解放軍第175醫(yī)院住院采集的45例患者,按隨機(jī)數(shù)字表法分為治療組23例、對(duì)照組22例。治療組(A組)采用射頻熱凝術(shù)治療后第2天結(jié)合腰椎牽引治療,對(duì)照組(B組)只采用射頻靶點(diǎn)熱凝術(shù)治療,對(duì)患者的癥狀、體征及疼痛程度等情況進(jìn)行觀察記錄,所有患者均進(jìn)行有效隨訪,隨訪時(shí)間2-12個(gè)月,平均10個(gè)月,利用臨床觀察量表,在治療前、治療后末次隨訪時(shí)采用視覺模擬評(píng)分(VAS)、下腰痛評(píng)價(jià)量表(JOA)、腰椎功能障礙評(píng)分(Roland-Morris)測(cè)定及運(yùn)用改良Macnab標(biāo)準(zhǔn)進(jìn)行臨床療效評(píng)定,比較兩組在治療椎間盤源性腰痛的綜合評(píng)分及療效評(píng)價(jià)。結(jié)果：統(tǒng)計(jì)分析顯示,A組VAS評(píng)分下降5.78±0.58,B組評(píng)分下降4.34士0.56,A組優(yōu)于B組；A組JOA評(píng)分提高13.07士1.90,B組提高6.82±1.90,.治療后分?jǐn)?shù)均較治療前提高,A組優(yōu)于B組,且A組評(píng)分較B組提高明顯;Roland-Morris分?jǐn)?shù)治療有所下降,A組Roland-Morris評(píng)分下降9.56±1.73,B組下降4.80±1.72, A組優(yōu)于B組,A組評(píng)分較B組減少明顯；改良MacNab臨床療效標(biāo)準(zhǔn)評(píng)定中,A組總有效率95.7%；B組總有效率為90.9%；兩組差異具有統(tǒng)計(jì)學(xué)意義(P0.05),A組優(yōu)于B組。結(jié)論：腰椎牽引結(jié)合射頻熱凝術(shù)與單純射頻熱凝術(shù)治療椎間盤源性腰痛兩種方法都有效,牽引的配合應(yīng)用可以更好地減少射頻熱凝術(shù)的術(shù)后并發(fā)癥。兩者結(jié)合具有療效確切、安全、操作簡(jiǎn)單、費(fèi)用較低、便于推廣等優(yōu)點(diǎn),是治療椎間盤源性下腰痛較為理想的方法之一,臨床值得推廣運(yùn)用。
[Abstract]:Objective: in recent years, discogenic low back pain has been paid more and more attention in clinic. It is a degenerative disease of lumbar intervertebral disc which is not mainly characterized by the compression of nerve tissue. Is one of the most intractable diseases. At present, there are three main methods of low back pain: conservative treatment, minimally invasive treatment and open surgery. Due to the invasive, risky and expensive treatment of open surgery, most patients can not accept it, so conservative treatment and minimally invasive treatment have become the choice of most patients. This paper discusses the primary curative effect and mechanism of lumbar traction combined with radiofrequency thermocoagulation in the treatment of discogenic low back pain, so as to provide a safe and feasible rehabilitation scheme for the treatment of discogenic low back pain. Methods: a total of 45 patients were randomly divided into treatment group (n = 23) and control group (n = 22). The treatment group (group A) was treated with radiofrequency thermocoagulation combined with lumbar traction on the second day after radiofrequency thermocoagulation, while the control group (group B) was treated with radiofrequency thermocoagulation only. The symptoms, signs and pain degree of the patients were observed and recorded. All the patients were followed up effectively, the follow-up time was 2-12 months (mean 10 months). Using the clinical observation scale, the visual analogue scale (VAS),) was used to evaluate low back pain (JOA),) before and after the last follow-up. Lumbar dysfunction score (Roland-Morris) and modified Macnab criteria were used to evaluate the clinical efficacy. The comprehensive score and evaluation of curative effect were compared between the two groups in the treatment of discogenic low back pain. Results: statistical analysis showed that the VAS score of group A decreased by 5.78 鹵0.58 渭 g / L, the score of group A decreased by 4.34 鹵0.56A was better than that of group B, and the JOA score of group A was increased by 13.07 鹵1.90 and 6.82 鹵1.90m respectively. The scores of group A were better than those of group B, and the scores of group A were significantly higher than those of group B. The Roland-Morris score decreased, the Roland-Morris score of group A decreased 9.56 鹵1.73%, the score of group B decreased 4.80 鹵1.72, the score of group A was better than that of group B, and the score of group A was significantly lower than that of group B. The total effective rate of group A was 90.9 in group A and the total effective rate in group B was 90.9.The difference between the two groups was statistically significant (P0.05), A group was better than B group. Conclusion: lumbar traction combined with radiofrequency thermocoagulation and radiofrequency thermocoagulation are effective in the treatment of discogenic low back pain. The combined application of traction can better reduce the postoperative complications of radiofrequency thermocoagulation. The combination of the two has the advantages of exact curative effect, safety, simple operation, low cost and easy to be popularized. It is one of the more ideal methods for the treatment of low back pain caused by intervertebral disc, and it is worth popularizing in clinic.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R687.3

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本文編號(hào)：2294551