【摘要】：目的:經(jīng)椎間孔選擇性神經(jīng)根阻滯術(shù)(Transforaminal selective nerve root block)是運(yùn)用靶點(diǎn)穿刺技術(shù)直達(dá)病灶解決病痛;虛痹方是我院林一峰教授在"溫養(yǎng)督脈理論"的基礎(chǔ)上自擬的臨床經(jīng)驗(yàn)方。本文通過臨床癥狀、實(shí)驗(yàn)室檢查等指標(biāo)觀察,客觀的評價(jià)兩種治療方案的臨床療效,為臨床治療腰椎間盤突出癥提供最佳的治療方案。方法:選取2015年2月～2016年2月在廣州中醫(yī)藥大學(xué)第三附屬醫(yī)院脊柱骨科將符合研究條件的72例患者納入研究,在簽署《患者治療方案知情同意書》的基礎(chǔ)上將患者隨機(jī)分為2組;試驗(yàn)A組:經(jīng)椎間孔選擇性神經(jīng)根阻滯術(shù)+脊柱科常規(guī)路徑治療;試驗(yàn)B組:虛痹方(服用療程4個(gè)療程,1個(gè)療程1周)+脊柱科常規(guī)路徑治療。隨訪12個(gè)月期間脫落4例,剔除3例(A組3例、B組4例),最終完成研究隨訪的65例患者(試驗(yàn)A組33例、試驗(yàn)B組32例)。治療前、治療后1天、1個(gè)月、6個(gè)月及12個(gè)月比較兩組血清中白介素6(IL-6)濃度,治療前、治療后1天、1個(gè)月、3個(gè)月、6個(gè)月及12個(gè)月比較兩組患者VAS評分、J0A評分及術(shù)后12個(gè)月Macnab優(yōu)良率,客觀評價(jià)兩種治療方案,從而找到更加快速、有效治療方案。結(jié)果:兩組患者一般資料(性別、年齡、年齡分布區(qū)間、病程及責(zé)任階段等)比較差異,均無統(tǒng)計(jì)學(xué)意義(P0.05),基本一致。術(shù)后第1天疼痛VAS評分及下腰痛J0A評分、血清中IL-6濃度經(jīng)椎間孔神經(jīng)根阻滯術(shù)組改善顯著,虛痹方組未見明顯改善;術(shù)后1個(gè)月、術(shù)后3個(gè)月兩組患者疼痛VAS評分、下腰痛J0A評分及術(shù)后1個(gè)月血清中IL-6濃度比較有顯著性差異(P0.05),經(jīng)椎間孔神經(jīng)根阻滯術(shù)組治療效果優(yōu)于虛痹方組。術(shù)后6個(gè)月兩組患者疼痛VAS評分、下腰痛J0A評分及血清中IL-6濃度比較無顯著性差異(P0.05),兩組治療效果相同。術(shù)后12個(gè)月兩組患者疼痛VAS評分、下腰痛J0A評分及血清中IL-6濃度比較有顯著性差異(P0.05),經(jīng)椎間孔神經(jīng)根阻滯術(shù)組療效降低,癥狀及體征反復(fù),虛痹方組治療效果優(yōu)于經(jīng)椎間孔神經(jīng)根阻滯術(shù)組。治療12個(gè)月后隨訪,虛痹方組總優(yōu)良率為90.63%,經(jīng)椎間孔神經(jīng)根阻滯術(shù)組總優(yōu)良率為66.67%。結(jié)論:本課題所選兩種治療方案均能有效改善虛痹型腰椎間盤突出癥患者癥狀及體征。從血清中IL-6濃度、疼痛VAS評分及下腰痛J0A評分指標(biāo)變化可知:兩組前3個(gè)月短期療效,經(jīng)椎間孔選擇性神經(jīng)根阻滯術(shù)組優(yōu)于虛痹方組;6個(gè)月療效基本一致,12個(gè)月中長期療效,虛痹方組優(yōu)于經(jīng)椎間孔選擇性神經(jīng)根阻滯術(shù)組。以中西醫(yī)結(jié)合理論為基礎(chǔ),把兩種治療方案有效結(jié)合,相得益彰,值得應(yīng)用。
[Abstract]:Objective: selective nerve root block through intervertebral foramen (Transforaminal selective nerve root block) is a clinical experience prescription based on the theory of warming and nourishing du pulse. By observing the clinical symptoms, laboratory examination and other indexes, this paper objectively evaluates the clinical efficacy of the two treatment schemes, and provides the best treatment scheme for the clinical treatment of lumbar disc herniation. Methods: from February 2015 to February 2016, 72 patients in the Department of Spine Orthopaedics, the third affiliated Hospital of Guangzhou University of traditional Chinese Medicine, were included in the study. Patients were randomly divided into two groups on the basis of signing "informed consent to patient treatment Scheme". Group A was treated with routine spinal pathway through intervertebral foramen selective nerve root block. Experimental group B: Xiubi prescription (4 courses of treatment, 1 week of treatment) spinal routine path therapy. During the 12 months follow-up, 4 cases were dropped off, 3 cases were removed (3 cases in group A, 4 cases in group B), 65 patients (33 cases in group A and 32 cases in group B) were finally followed up. Before treatment, 1 day, 1 month, 6 months and 12 months after treatment, the serum levels of interleukin 6 (IL-6) were compared between the two groups. After 1 day, 1 month, 3 months, 6 months and 12 months after treatment, the VAS score of J0A and the excellent and good rate of Macnab at 12 months after treatment were compared between the two groups, and the two treatment schemes were evaluated objectively, so as to find a more rapid and effective treatment scheme. Results: there was no significant difference between the two groups in general data (sex, age distribution interval, course of disease and responsibility stage) (P0.05). On the first day after operation, the VAS score of pain and the J0A score of low back pain were significantly improved in the serum IL-6 concentration in the intervertebral foramen nerve root block group, but not in the deficiency bi prescription group, and the pain VAS score in the two groups was significantly improved at 1 month and 3 months after operation. There was significant difference in J0A score of lower back pain and serum IL-6 concentration 1 month after operation (P0.05). The effect of nerve root block through intervertebral foramen was better than that of Xibi Fang group. There was no significant difference in pain VAS score, lower back pain J0A score and serum IL-6 concentration between the two groups 6 months after operation (P0.05). There were significant differences in pain VAS score, lower back pain J0A score and serum IL-6 concentration between the two groups 12 months after operation (P0.05). The effect of deficiency-bi prescription group was better than that of intervertebral foramen nerve root block group. After 12 months follow-up, the total excellent and good rate of Xiubi prescription group was 90.63 and that of intervertebral foramen nerve root block group was 66.67. Conclusion: the two treatments can effectively improve the symptoms and signs of the patients with asthenia-arthralgia type lumbar disc herniation. From the changes of serum IL-6 concentration, VAS score of pain and J0A score of low back pain, we can see that the short-term curative effect of the two groups in the first 3 months, the selective nerve root block through intervertebral foramen group is better than that in the deficiency Bi prescription group, the curative effect is basically the same at 6 months, and the medium and long term curative effect at 12 months. The deficiency bi prescription group was superior to the selective nerve root block group through intervertebral foramen. Based on the theory of integration of traditional Chinese and western medicine, the two therapeutic schemes are effectively combined to complement each other and are worthy of application.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R274.9

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