腰椎间盘突出症两种药物保守治疗的疗效比较

Conservative Treatment of Lumbar Disc Herniation:Mecobalamin Intravenous Drip Compared with Corticosteroid

目的探讨在腰椎间盘突出症保守治疗中,短期静脉滴注甲钴胺对患者的下肢放射性疼痛及神经功能改善情况的影响,分析其临床疗效。方法124例腰椎间盘突出症患者行保守治疗,其中治疗组62例短期静脉滴注甲钴胺,另对照组62例短期静脉滴注泼尼松。治疗前及治疗后2 h、6 h、1 d、3 d、6 d和8 d时,采用VAS法进行放射性疼痛评分及Lasegue征角度测量,评估患者神经功能恢复情况;在治疗停药后,调查患者放射性疼痛、麻木的改善情况,总结主观症状改善率。结果治疗组患者在治疗末期的放射性疼痛改善程度优于对照组,而且停药2 d后尤其明显(P<0.05);Lasegue征角度仅在停药2 d后改善程度优于对照组,且有统计学意义(P<0.05);保守治疗后患者放射性疼痛(P>0.05)、麻木(P<0.05)的改善率均较高。结论甲钴胺能有效缓解下肢放射性疼痛、麻木,可弥补糖皮质激素疗效的不足,值得进一步探讨和研究,具有广阔的应用前景。

Objective To evaluate short term outcome of intravenous drip of rnecobalamin in the conservative treatment of lumbar disc herniation. Methods In 124 cases with lumbar disc herniation, 62 received short term intravenous drip of mecobalamin,and the other 62 cases received intravenous methylprednisolone. VAS pain scale and I.asegue score was used to record the degree of the patients＇ radicular pain before the treatment,2 hours, 6 hours, 1 day,3 days,6 days and 8 days after the treatment to evaluate the recovery, investigate on the improvement rate about the symptom of radicular pain and numbness. Results The patients in the mecobalamin group got significant pain relief in the end of treatment. After drug withdrawal for 2 days,the difference of Lasegue score between the mecobal amin and methylprednisolone group was significant. The improvement rate about the subjective symptoms were both satisfactory. Conclusion Mecobalamin can relieve radicular pain and numbness of the lower limbs effectively,and make up for the deficiency of glucocorticoid treatment. Therefore ,mecobalamin might have brighter future ,but needs further discussion and research.