玻璃酸钠治疗腰椎间盘突出症136例随访

Sodium hyaluronate for lumbar disc herniation:a follow-up in 136 cases

目的:通过应用玻璃酸钠治疗腰椎间盘突出症的疗效观察,为椎间盘损伤引起的盘源性下腰痛选择最佳治疗方法。方法:2003-01/2004-05在南京医科大学第一附属医院康复医学科完成本项工作。136例慢性腰腿痛急性发作,经CT及MRI证实为腰椎间盘突出,选择玻璃酸钠硬膜外注射术治疗。其中选择L4～5椎间隙为硬膜外穿刺术87例。L3～4椎间隙硬膜外穿刺术49例。分别于术前,术后对患者的腰腿痛情况进行目测类比评分(VAS)评定,同时评估腰椎硬膜外穿刺术后的疗效。结果:术后随访时间6～19个月,平均11.5个月。87例行L4～5椎间隙硬膜外穿刺术者注射前腰腿痛评分平均8.9分,注射后平均2.7分。83例术后腰腿痛症状基本消失,4例仍有轻度的腰痛,有效率为95.4%(83/87)。49例行L3～4椎间隙硬膜外穿刺术者注射前腰腿痛评分平均8.5分,注射后平均3.6分。46例腰腿痛症状基本消失,3例仍有轻度腰腿痛。有效率为93.8%(46/49)。136例患者注射前后腰腿痛评分比较,差异均有非常显著性意义(P<0.01)。结论:玻璃酸钠应用于硬膜外治疗腰椎间盘突出是一种有效的方法。但应严格掌握硬膜外治疗的适应证。

AIM:To observe the curative effect of sodium hyaluronate(SH) in treating lumba r disc herniation(LDH) so as to select optimal methods for the treatment of disc derived low back pain caused by intervertebral disc injury. METHODS:The experiment was conducted in the Department of Rehabilitation Medic ine,First Affiliated Hospital of Nanjing Medical University from January 2003 to May 2004.Totally 136 patients with chronic pain of low back and leg who broke o ut acutely proved by CT and MRI as LDH were treated with epidural injection of S H.Of the 136 cases,87 were treated with puncturing epidural space at lumbar 4 to 5 segment,and 49 treated with puncturing epidural space at lumbar 3 to 4 segmen t.The clinical results were evaluated by pre and post operative visual anologu e scale(VAS),and the curative effect of puncturing the epidural space of lumbar vertebrae was also evaluated. RESULTS:The average period of follow up was 11.5 months,ranging from 6 to 19 months.The pre and post injection scores of VAS in 87 cases treated with punct uring epidural space at L4-5 were 8.9 and 2.7 points respectively,among whom 83 basically disappeared pain of low back and leg,and 4 complained of mild pain,so the effective rate was 95.4%(83/87).The pre and post injection scores of VAS in 49 cases treated with puncturing epidural space at L3-4 were 8.5 and 3.6 po ints respectively,of whom 46 basically disappeared pain of low back and leg,and 3 complained of mild pain,so the effective rate was 93.8%(46/49).The scores of VAS after injection of SH were significantly different from that before injectio n in the 136 cases(P< 0.01). CONCLUSION:It is an effective method to treat LDH by injecting SH into epidura l space,but the indication for epidural treatment should be mastered well.