本文選題：腰椎關(guān)節(jié)突關(guān)節(jié)源性腰痛 + 射頻消融術(shù)��； 參考：《廣西中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的:通過對(duì)射頻熱凝靶點(diǎn)消融術(shù)聯(lián)合中藥藥?kù)侬煼ㄖ委熝店P(guān)節(jié)突關(guān)節(jié)源性腰痛的臨床研究,觀察其臨床治療效果,探尋一種創(chuàng)傷比較小,安全性相對(duì)比較高、療效明確且長(zhǎng)期療效穩(wěn)定的腰椎關(guān)節(jié)突關(guān)節(jié)源性腰痛的治療方法。方法:從月2013年10月-2015年01月在廣西中醫(yī)藥大學(xué)第一附屬醫(yī)院住院部,收集通過脊神經(jīng)后內(nèi)側(cè)支封閉術(shù)確診的腰椎關(guān)節(jié)突關(guān)節(jié)源性腰痛的患者98例,作為研究對(duì)象。所有患者按照住院號(hào)順序隨機(jī)分為三組。35例患者入選A組(手術(shù)聯(lián)合保守治療組),采用射頻熱凝消融術(shù)、臭氧注射、口服塞來昔布膠囊、紅外線治療、中藥涂擦及中藥藥?kù)侬煼ǖ仁中g(shù)聯(lián)合保守療法進(jìn)行治療;33例患者入選B組(單純手術(shù)組),進(jìn)行射頻熱凝消融術(shù)、臭氧注射等單純手術(shù)療法;30例患者入選C組(單純保守治療組),進(jìn)行口服塞來昔布膠囊、紅外線治療、中藥涂擦及中藥藥?kù)侬煼ǖ葐渭儽Ｊ刂委煼椒ㄟM(jìn)行治療。三組所有患者均符合腰椎關(guān)節(jié)突關(guān)節(jié)源性腰痛的納入標(biāo)準(zhǔn),通過脊神經(jīng)后內(nèi)側(cè)支封閉術(shù)確診,排除腰椎間盤突出癥、腰椎骨折、腰椎管狹窄癥等特異性疾病,消化系統(tǒng)等嚴(yán)重的內(nèi)疾病,孕婦及哺乳期婦女,精神障礙等患者。所有患者依從性好,無(wú)病例脫落現(xiàn)象。A組:男22例,女13例,平均年齡65.05±8.38歲;疼痛時(shí)間平均68.12±9.08月;受累的脊神經(jīng)后內(nèi)側(cè)支L2-3節(jié)段的患者7例,L3-4節(jié)段的患者15例,L4-5節(jié)段的患者13例;VAS評(píng)分平均7.45±1.09分,腰椎JOA評(píng)分平均為15.02±1.42。B組:男19例,女14例,平均年齡68.12±9.08歲;疼痛時(shí)間平均117.33±7.77月;受累的脊神經(jīng)后內(nèi)側(cè)支L2-3節(jié)段的患者6例,L3-4節(jié)段的患者17例,L4-5節(jié)段的患者10例;VAS評(píng)分平均6.36±1.08分,腰椎JOA評(píng)分15.48±0.90分。C組:男16例,女14例,平均年齡63.12±4.01歲;疼痛時(shí)間平均49.33±2.07月;受累的脊神經(jīng)后內(nèi)側(cè)支L2-3節(jié)段的患者4例,L3-4節(jié)段的患者14例,L4-5節(jié)段的患者12例;VAS評(píng)分平均6.40±1.13分,腰椎JOA評(píng)分平均17.83±1.53分。三組患者的性別、年齡、脊神經(jīng)后內(nèi)側(cè)支責(zé)任節(jié)段的人數(shù)等方面的一般資料,沒有明顯的差異性(P0.05),具有可比性。將三組患者分別進(jìn)行射頻熱凝靶點(diǎn)消融術(shù)聯(lián)合中藥藥?kù)侬煼ㄖ委熍c單純手術(shù)、單純保守治療,觀察其臨床療效。治療方法:A組(手術(shù)聯(lián)合保守治療組):使用射頻控溫?zé)崮鬟M(jìn)行治療。先進(jìn)行電刺激測(cè)試:設(shè)置感覺神經(jīng)刺激測(cè)試50Hz頻率、電流為0m A-2.0m A,運(yùn)動(dòng)神經(jīng)測(cè)試頻率為2Hz,電流為0m A-2.0m A,當(dāng)患者復(fù)制疼痛癥狀及腰部肌跳動(dòng)時(shí)為測(cè)試成功。然后啟動(dòng)連續(xù)射頻熱凝模式,調(diào)整溫度為65℃-70℃,周期為60秒。每個(gè)穿刺點(diǎn)3個(gè)周期。射頻熱凝消融術(shù)后,再使用醫(yī)用臭氧發(fā)生器產(chǎn)生的O3-O2混合性氣體,濃度為25mg/L,用注射器抽取5ml-10ml。注射入每個(gè)靶點(diǎn)進(jìn)行臭氧消融術(shù)。根據(jù)具體病情的需要,酌情重復(fù)上述過程。術(shù)后予以口服塞來昔布膠囊、中藥燙熨療法、中藥涂擦、特定電磁波譜(TDP)治療儀等保守治療。B組(單純手術(shù)組):采用射頻靶點(diǎn)熱凝消融術(shù)、臭氧注射;C組(單純保守治療組):采用口服塞來昔布,1次/日,200mg/次。治療2周后停藥。記錄患者消化系統(tǒng)等不良反應(yīng)。并予以中藥燙熨療法、中藥涂擦、特定電磁波譜治療儀等理療。觀察指標(biāo):采用視覺模擬測(cè)試表(VAS)進(jìn)行療效評(píng)價(jià)。記錄治療前后不同時(shí)間段的VAS評(píng)分、腰椎JOA評(píng)分及其改善率。統(tǒng)計(jì)學(xué)分析:對(duì)所有數(shù)據(jù)使用SPSS17.0軟件進(jìn)行統(tǒng)計(jì)學(xué)分析。采用重復(fù)測(cè)量資料的方差分析對(duì)三組治療前后不同時(shí)間的VAS評(píng)分、腰椎JOA評(píng)分進(jìn)行組內(nèi)比較有無(wú)差異性,對(duì)于三組在治療后各個(gè)時(shí)間點(diǎn)的VAS評(píng)分、腰椎JOA評(píng)分的比較,應(yīng)用方差分析-LSD檢驗(yàn)比較治療后各個(gè)時(shí)間上三組患者的VAS評(píng)分、腰椎JOA評(píng)分進(jìn)行組間比較有無(wú)差異性。對(duì)三組間腰椎JOA評(píng)分改善率采用χ2檢驗(yàn)比較其差異性。以P0.05為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.VAS評(píng)分比較A組:治療后1天、3個(gè)月、6個(gè)月、1年不同時(shí)間點(diǎn)的VAS評(píng)分與治療前相比均有所下降(P0.05),說明A組治療有效;治療后1天、3個(gè)月、6個(gè)月、1年不同時(shí)間點(diǎn)其VAS評(píng)分組內(nèi)比較沒有明顯統(tǒng)計(jì)學(xué)差異(P0.05),說明A組治療,起效快,效果顯著,療效持久穩(wěn)定。B組:治療后1天、3個(gè)月、6個(gè)月、1年不同時(shí)間點(diǎn)與治療前相比均降低(P0.05),說明B組治療有效;但是治療后6個(gè)月、1年其VAS評(píng)分沒有明顯統(tǒng)計(jì)學(xué)差異(P0.05),說明B組治療遠(yuǎn)期效果欠佳。C組:治療后1天、3個(gè)月其VAS評(píng)分沒有明顯統(tǒng)計(jì)學(xué)差異(P0.05);治療后6個(gè)月、1年VAS評(píng)分低于治療前(P0.05),說明C組起效慢,療效穩(wěn)定。三組間比較:在治療后1天、3個(gè)月、6個(gè)月、1年不同時(shí)間點(diǎn)的VAS評(píng)分,A組療效優(yōu)于B組、C組,B組療效優(yōu)于C組(P0.05)。2.腰椎JOA評(píng)分比較A組:治療后1天、3個(gè)月、6個(gè)月、1年不同時(shí)間點(diǎn)的JOA評(píng)分與術(shù)前相比均有所升高(P0.05),說明A組治療有效;治療后1天、3個(gè)月、6個(gè)月、1年不同時(shí)間點(diǎn)其JOA評(píng)分組內(nèi)比較沒有明顯統(tǒng)計(jì)學(xué)差異(P0.05),說明A組治療,起效快,效果顯著,療效持久穩(wěn)定。B組:治療后1天、3個(gè)月、6個(gè)月、1年不同時(shí)間點(diǎn)與治療前相比均升高(P0.05),說明B組治療有效;但是治療后6個(gè)月、1年其JOA評(píng)分沒有明顯統(tǒng)計(jì)學(xué)差異(P0.05),說明B組治療遠(yuǎn)期效果欠佳。C組:治療后1天、3個(gè)月其VAS評(píng)分沒有明顯統(tǒng)計(jì)學(xué)差異(P0.05);治療后6個(gè)月、1年高于治療前(P0.05),治療后6個(gè)月、1年高于治療前(P0.05),說明C組起效慢,療效穩(wěn)定。三組間比較:在治療后1天、3個(gè)月、6個(gè)月、1年不同時(shí)間點(diǎn)的VAS評(píng)分,A組療效優(yōu)于B組、C組,B組療效優(yōu)于C組(P0.05)。結(jié)論:射頻熱凝靶點(diǎn)消融術(shù)聯(lián)合中藥藥?kù)侬煼�、單純手術(shù)治療、單純保守療法均是治療腰椎關(guān)節(jié)突關(guān)節(jié)源性腰痛的有效方法。射頻熱凝靶點(diǎn)消融術(shù)聯(lián)合中藥藥?kù)僦委熎鹦Э?效果顯著,療效持久穩(wěn)定,不易復(fù)發(fā);單純手術(shù)治療起效快,效果明顯,但是長(zhǎng)期療效不理想,容易復(fù)發(fā);單純保守治療起效慢,治療效果有效,療效持久。所以射頻消融術(shù)聯(lián)合中藥藥?kù)僦委煹寞熜П葐渭兪中g(shù)治療、單純保守治療效果好,值得在臨床推廣。
[Abstract]:Objective: through the clinical study of radiofrequency thermocoagulation target ablation combined with traditional Chinese medicine ironing therapy for lumbar joint protruding lumbago, the clinical therapeutic effect was observed, and a method of treatment for lumbar joint source lumbago with relatively small trauma, relatively high safety and long-term curative effect was explored. In October 2013, -2015, -2015, at the First Affiliated Hospital of Guangxi University of traditional Chinese medicine, 98 patients with lumbar joint protrusion lumbar pain diagnosed by posterior medial branch of the spinal nerve were collected as the research object. All patients were randomly divided into three groups of.35 patients according to the order of hospitalization (surgery combined with conservative treatment group). Using radiofrequency thermocoagulation, ozone injection, oral Celecoxib Capsules, infrared therapy, traditional Chinese medicine and herbal medicine ironing, 33 patients were enrolled in group B (simple operation group), radiofrequency thermocoagulation, ozone injection and other simple surgical treatments, and 30 patients were enrolled in group C (simple conservative treatment). Group of three groups were treated with simple conservative treatment such as Celecoxib Capsules, infrared therapy, traditional Chinese medicine and herbal medicine ironing. All patients in the group were in accordance with the standard of lumbar joint protruding lumbago. The lumbar intervertebral disc herniation, lumbar fracture, and lumbar spinal canal stenosis were excluded through the posterior medial branch closure of the spinal nerve. Severe internal diseases such as narrow disease, digestive system and other serious internal diseases, pregnant women and lactation women, mental disorders and so on. All patients have good compliance and no case fall phenomenon.A group: 22 men, 13 women, average age 65.05 + 8.38 years; the average time of pain is 68.12 + 9.08 months; 7 patients with L2-3 segment of the medial posterior medial branch of the spinal nerve, L3-4 section. There were 15 patients in the segment and 13 patients in L4-5 segment; the average VAS score was 7.45 + 1.09 and the average of the lumbar JOA score was 15.02 + 1.42.B. The average age was 68.12 + 9.08, the average age was 68.12 + 9.08; the average pain time was 117.33 + 7.77 months; the victims of the L2-3 segment of the posterior medial branch of the spinal nerve, 17, L4-5, VAS, VAS, VAS, VAS, VAS, VAS, VAS, and VAS. The average score of the score was 6.36 + 1.08 points, and the JOA score of the lumbar spine was 15.48 + 0.90.C groups: 16 men and 14 women, with an average age of 63.12 + 4.01 years; the average pain time was 49.33 + 2.07 months; the patients with the L2-3 segment of the posterior medial branch of the spinal nerve were 4, the patients in the segment of the L4-5 segment, and the patients of the L4-5 segment were 12; the average VAS score was 15.48, and the JOA score of the lumbar spine was averaged. There was no significant difference (P0.05) in the gender, age, and the number of the number of the posterior medial branch of the spinal nerve (P0.05). The three groups of patients were treated with radiofrequency coagulation target ablation combined with traditional Chinese medicine ironing treatment and simple operation, and the treatment was treated with simple conservative treatment, and the clinical curative effect was observed. Treatment: A group (operation combined with conservative treatment group): use the radiofrequency temperature control thermocoagulator for treatment. Advanced electrical stimulation test: set the sensory nerve stimulation test 50Hz frequency, current 0m A-2.0m A, motor nerve test frequency 2Hz, current 0m A-2.0m A, when patients recover pain symptoms and waist muscle beating success. Then start the test. Then start up. The continuous radiofrequency thermocoagulation mode was adjusted at 65 C -70 C and 60 seconds. Each puncturing point was 3 cycles. After radiofrequency ablation, the O3-O2 mixed gas produced by the medical ozone generator was used for 25mg/L, and 5ml-10ml. was injected into each target with syringe and injected into each target. Repeat the process. After the operation, the oral Celecoxib Capsules, Chinese medicine ironing therapy, traditional Chinese medicine scrubbing, specific electromagnetic spectrum (TDP) therapy instrument and other conservative treatment group.B (simple operation group) were treated with radiofrequency target thermocoagulation, ozone injection, C group (simple conservative treatment group): oral celecoxib, 1 times / day, 200mg/ times. After 2 weeks, the drug was stopped. The patient's digestive system and other adverse reactions were recorded, and traditional Chinese medicine ironing therapy, Chinese medicine smear, specific electromagnetic spectrum therapy instrument and other physiotherapy were given. The observation index: the visual analogue test table (VAS) was used to evaluate the curative effect. The VAS score of different time periods before and after the treatment, the JOA score and the improvement rate of the lumbar spine were recorded. Statistical analysis: the use of SPS for all data S17.0 software for statistical analysis. The variance analysis of repeated measurement data was used to compare the VAS scores of the three groups at different times before and after treatment, and there was no difference in the group of lumbar JOA scores. For the three groups, the VAS score at each time point after treatment and the comparison of the lumbar JOA score should be compared with the variance analysis -LSD test to compare the time after treatment. There was no difference between the VAS scores of the upper three groups and the JOA score of the lumbar spine. The difference between the three groups was compared with the x 2 test. The difference between the P0.05 and the 1.VAS scores was statistically significant. Results: the 1.VAS score was compared with the A group: the VAS scores of the 3 months, 6 months and 1 years at different time points were compared with those before the treatment. The decrease (P0.05) showed that the treatment of group A was effective, 1 days, 3 months, 6 months, 1 years and different time points in the VAS score group had no significant statistical difference (P0.05), indicating that group A treatment was fast and effective, the curative effect was lasting and stable.B group: 1 days after treatment, 3 months, 6 months, and 1 years at different time points were lower than before treatment (P0.05), The treatment of group B was effective, but there was no significant difference in VAS score between 6 months and 1 years after treatment (P0.05), indicating that the long-term effect of B group was not good in.C group: 1 days after treatment and 3 months, there was no significant difference in VAS score (P0.05); 6 months after treatment, 1 year VAS score was lower than before treatment (P0.05), indicating that C group was slow and stable. Three groups were stable. Three groups were stable. Comparison: 1 days after treatment, 3 months, 6 months, 1 years of VAS score at different time points, group A was better than group B, group C, group C, group B and C group (P0.05).2. lumbar JOA score compared to group A group: 1 days after treatment, 3 months, 6 months, 1 years at different time points were higher than before operation (P0.05), indicating that the treatment was effective on 1 days, 3 months after treatment, 6, 3 months, 6. In 1 years, there was no significant difference in JOA score group (P0.05) at different time points (P0.05), indicating that group A was treated with rapid effect and significant effect. The curative effect was stable and stable.B group: 1 days, 3 months, 3 months, 1 years at different time points were all higher than before treatment (P0.05), indicating that group B was effective, but the JOA score of the group was 6 months after treatment, and 1 years did not score the JOA score. There were significant statistical differences (P0.05), indicating that the B group had poor long-term effect in group.C: 1 days after treatment and 3 months after the treatment, there was no significant difference in VAS score (P0.05); 6 months after treatment, 1 years higher than before treatment (P0.05), 6 months after treatment, 1 years higher than before treatment (P0.05), indicating that the C group had a slow onset and a stable effect. The three groups were compared at 1 days after treatment, 3. 6 months, 6 months, 1 years at different time points, A group effect is better than group B, group C, group B effect is better than group C (P0.05). Conclusion: radiofrequency thermocoagulation target ablation combined with traditional Chinese medicine ironing therapy, simple surgical treatment, simple conservative therapy are effective methods for the treatment of lumbar joint protruding low back pain. Radiofrequency ablation target ablation combined with traditional Chinese Medicine The curative effect is fast, the effect is remarkable, the curative effect is stable and stable, it is not easy to recur; the simple operation treatment is fast, the effect is obvious, but the long-term effect is not ideal, it is easy to recur; the simple conservative treatment is slow, the treatment effect is effective and the curative effect is lasting. So the curative effect of radiofrequency ablation combined with Chinese medicine ironing is better than the simple surgical treatment and the simple conservative treatment. The therapeutic effect is good and it is worth popularizing in the clinic.
【學(xué)位授予單位】：廣西中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R274.9

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