腰骶部筋膜脂肪疝所致下腰痛的治疗效果分析

Treatment of low back pain caused by fascial fat hernia in lumbosacral region

目的:比较封闭与手术方法治疗腰骶部筋膜脂肪疝的临床效果。方法:选择2002-10/2005-04吉林大学第二临床医院骨科收治的腰骶部筋膜脂肪疝患者31例,男:女比例为1∶9.3;病程平均4年零1个月。单侧23例,双侧8例。31例患者均有腰骶部痛性结节,单纯下腰部疼痛者9例,下腰痛伴患侧臀部及大转子部放散痛者18例,下腰痛放散至患侧臀部及大腿后外侧者4例;本组均无神经系统阳性体征。①封闭疗法:31例均采用封闭治疗。采用醋酸氢泼尼松混悬液25mg+20g/L利多卡因注射液5～10mL+生理盐水稀释1倍后,注射于痛性结节的(扳机点)基底部及周围,1次/周,4次为1个疗程。封闭1个疗程后即停药随访6个月。②手术方法:封闭后6个月内复发者行手术治疗,31例均复发并行手术将肿物和与蒂部相连的筋膜下脂肪组织广泛切除。③观察封闭1个疗程、术后1个月、封闭1个疗程随访6个月、术后随访6个月治疗效果、总有效率;术后并发症发生情况。疗效评价标准分为优、良、可、差;封闭停止后6个月及术后6个月疗效评价达到优和良者为临床治愈。结果:术后6个月随访时失访2例,其他各时间段疗效评估31例均进入结果分析。①封闭与手术治疗效果:术后1个月时总有效率与封闭1个疗程时比较差异无显著性意义96.7%(30/31),93.5%(29/31);χ2=0.35,P>0.05;术后6个月随访时临床治愈率显著高于封闭1个疗程随访6个月时93.1%(27/29),6.9%(2/31),χ2=45.05,P<0.05。②不良事件及副反应:腰骶部皮肤痛觉减退4例,均为无蒂型脂肪疝,术后6个月随访时,3例恢复正常,1例明显改善。所有术后患者均有不同程度局部瘢痕粘连。术后6个月随访时局部瘢痕粘连明显减轻。结论:封闭同手术治疗近期有效率差别无统计学意义;手术治疗临床治愈率明显优于封闭治疗。

AIM： To compare the clinical effects of fascial fat hernia in lumbosacral region treated with blocking and operation respectively. METHODS： From October 2002 to April 2005, thirty-one patients with low back pain （LBP） due to lumbosacral fascia fat hernia were enrolled from the Department of Orthopedics, Second Clinical Hospital of Jilin University. With the male： female ratio of 1：9.3 and the average disease course of four years and one month, all the patients （23 cases of unilateral pain and 8 cases of bilateral pain） were found sacrodynia nods, including 9 ones with pure LBP, 18 ones with LBP accompanying diseased buttock and great trochanter diffused pains, 4 ones with diseased buttock and thigh back lateral pain without nervous system positive sign. ①Blocking treatment： Totally 31 patients were taken as subjects, whose basilar part of painful nods and circumference were injected with 25 mg acetic acid prednisone suspension ＋ 20 g/L 5-10 mL lignocaine ＋ diluted saline, once per week for a course of four times. After the drug withdrawal, the follow-up was performed for 6 months. ②Operation treatment： All the 31 patients were relapsed in the follow-ups and conducted operations to extensively reseet the lump and fascia fat tissues linked with pedicel. ③Tbe curative effect, total effective rate and postoperative complications were observed at one-course blocking, postoperative one-month, 6-month follow-up after onecourse blocking anti 6-month follow-up after operation respectively. The curative effects were evaluated as excellent, good, fair and bad as well as clinical healing if excellent or good at 6 months after blocking and operations respectively. RESULTS： There were 2 withdrawals in the 6-month follow-ups after operation, so the effect evaluations of 31 patients at other times were involved in the result analysis. ①Curative effects of blocking and operation： there was no significant difference in the total effective rates at postoperative one-month and after one-course blocking [96.7%（30/31）, 93.5%（29/31）; x^2=0.35, P 〉 0.05]; The effective rats were significantly higher in the 6- month follow-up after operation than in the 6-month follow-up after one- course blocking [93.1%（27/29）, 6.9%（2/31）, x^2=45.05, P 〈 0.05].②Adverse occurrence and side effect： Among 4 patients with skin hypalgesia which were all fat hernia without pedicel, there were 3 ones got normal recovery and 1 improved remarkably in the 6-month follow-ups after operation. Local scar adherence of different degrees were found in all the post-operative patients, and relieved obviously in the 6-month follow-ups after operation. CONCLUSION： There is no statistics meaning in the difference of shortterm effective rates between operation and blocking. The clinical healing rate of operation is obviously better than that of blocking.