硬膜外隙注药与三维正脊仪及其联合应用治疗腰椎间盘突出症的效果评价

Evaluation of the curative effects on lubar intervertebral disc protrusion with extradural injection,three dimensional rectification apparatus and their integrated therapy

目的:腰椎间盘突出症的非手术疗法中首推硬膜外隙注药和三维正脊仪治疗。对比硬膜外隙注药与三维正脊仪治疗腰椎间盘突出症的疗效,探讨两种疗法联合的可能性。方法:选择2003-01/2005-01解放军总医院康复医学科诊治的腰椎间盘突出症患者180例,随机数字表法分为3组,硬膜外隙注药组、三维正脊组、三维正脊及注药联合组,每组60例。注药组应用硬膜外注射20g/L利多卡因、胞二磷胆碱、维生素B12、地塞米松混合液,每5d注药1次,共4次。三维正脊组采用三维正脊仪,施行1次/周,共2次,三维正脊组及注药联合组为上述两种方法并用,每注药两次后行三维正脊仪1次。比较各组患者治疗前、治疗后3,6个月的疼痛数字评分及治疗后3个月的临床体征情况及疗效结果。疗效评定标准:①痊愈。腰腿疼痛消失,临床体征均转为阴性,可恢复工作。②有效。腰腿疼痛基本消失,临床体征两三项转为阴性,可作轻微工作。③好转。腰腿疼痛减轻,临床体征有1项转为阴性,尚需继续治疗。④无效。治疗前后疼痛与体征无变化。结果:所有患者均完成治疗和指标评定,全部进入结果分析。①治疗3个月硬膜外隙注药组、三维正脊组、三维正脊及注药联合组疼痛数字评分值与治疗前相比均有降低,而联合组更为明显(χ2=2.12,P<0.01)。治疗后6个月,各组病例的疼痛症状大多数获得控制,以联合组更为明显。其中联合组与前2组差异有显著性意义(χ2=4.02,P<0.01)。注药组与三维正脊组,联合组与注药组相比差异也有显著性意义(χ2=5.61,6.15,P<0.05)。②各组治疗后3个月4项体征均较治疗前明显改善。尤其是直腿抬高试验阳性率,联合组与注药组,联合组与三维正脊组相比差异非常显著性意义(χ2=9.23,9.13,P<0.01),而注药组与三维正脊组相比差异无显著性意义(χ2=11.6,P>0.05)。③硬膜外隙注药组、三维正脊组、三维正脊及注药联合组的有效率(痊愈及有效)分别为75%,72%和92%,联合组与硬膜外隙注药组、联合组与三维正脊组相比差异有非常显著性意义(χ2=6.25,6.03,P<0.01),而硬膜外隙注药组和三维正脊组之间差异无显著性意义(χ2=8.62,P>0.05)。结论:硬脊膜外注药、三维正脊仪治疗腰椎间盘突出症均有较高疗效,联合应用的治愈率高,临床体征转阴率高,预后好,无不良反应。硬脊膜外注药和三维正脊联合应用疗效高。

AIM： Both of extradural injection （EI） and three dimensional rectification apparatus treatment （TDRAT） are best conservative therapies of lubar intervertebral disc protrusion （LIDP）. To compare the curative effects of above-mentioned two therapies and probe into the possibility of integrated therapy of them. METHODS： 180 patients with LIDP between January 2003 and January 2005 were selected from the Department of Rehabilitation Medicine, Chinese PLA General Hospital and randomly divided into three groups： El group, TDRAT group and integrated group with 60 patients in each group. Patients in the El group received epidural injection of mixed liquor of 20 g/L lidocaine, citicoline, vitamin B12 and dexamisone once every 5 days for totally 4 times. The 3-D rectification apparatus was adopted to treat patients in the TDRAT group once a week for totally twice. Patients in the integrated group received integrated treatment of both former groups. The 3-D rectification apparatus was used once after every two or three times of injection. The pain scores at 3 and 6 months before and after the treatment , clinical presentations and the curative effects of 3 months after treatment were＂ compared among all groups. Evaluation criteria of the curative effects：①Healed： The patients could return to work with no back leg pain and the clinical representations were negative.②Effective： patients can afford light work with back leg pain essentially disappeared and 2 or 3 signs turned to negative. ③Improved： patients need further treatment with 1 back leg pain relieved and one sign turned to negative.④Ineffective： no alleviation. RESULTS： All patients accomplished the treatment and index-evaluation, and were involved in the analysis of results. ①Three months after treatment, the scores of pain evaluation were reduced in three groups than those before treatment, and that in the integrated group was more obvious （X^2=2.12 P 〈 0.01）. Six months after treatment, the pain symptom in most patients of all groups were controlled, especially in patients of integrated group, which was greater different from that in the former two groups （X^2 =4.02 P 〈 0.01）. There were significant differences between the El group and TDRAT group as well as between the integrated group and El group （X^2=5.61, 6.15, P 〈 0.05）.②Four signs in 3 groups after treatment were obviously ameliorated than those before treatment, especially the positive rate in straight-leg raising test, there were significant differences between integrated group and El group as well as the integrated group and TDRAT group （X^2=9.23, 9.13, P 〈 0.01）, while no marked difference was found between EI group and THRAT group （X^2=11.6, P 〉 0.05）.③The effective rate in El group, TDRAT group and integrated group was 75%, 72% and 92% respectively, and there were significant differences between integrated group and El group, integrated group and TDRAT group （X^2=6.25, 6.03, P 〈 0.01）, while there was no obvious difference between El group and TDRAT group （X^2=-8.62, P 〈 0.05）. CONCLUSION： Both of extradural injection and 3-D rectification apparatus treatment have good effects on LIDP, while the healing rate of integrated treatment with above-mentioned therapies is the best, which has high negative rate in clinical representations and better prognosis without obvious side-effects. High curative effect can be achieved by integrating El and TDRAT.