针刺结合神经阻滞治疗腰椎间盘突出症疗效观察

Clinical observation on acupuncture combined with nerve block for treatment of lumbar disc herniation

目的:探寻治疗腰椎间盘突出症的较佳疗法。方法:将90例腰椎间盘突出症患者随机分为针刺加神经阻滞组、针刺组和神经阻滞组,每组30例。针刺加神经阻滞组采用针刺结合神经阻滞治疗,选择L2-L5夹脊穴、秩边、环跳及阳陵泉等穴进行针刺,选择病变累及神经根、坐骨神经或腓总神经注射消炎镇痛液进行阻滞;针刺组单纯采用针刺治疗;神经阻滞组单纯采用神经阻滞治疗。治疗4周后,比较3组患者的疼痛视觉模拟评分(VAS)、Oswestry腰椎功能障碍指数(ODI)及改良MacNab标准,评价疗效。结果:与治疗前相比,3组患者治疗1、2、4周后VAS和ODI显著降低(均P<0.01);治疗1周时神经阻滞组和针刺加神经阻滞组的VAS、ODI评分显著低于针刺组(P<0.05),治疗2周和4周时针刺加神经阻滞组VAS、ODI评分显著低于针刺组和神经阻滞组(P<0.05)。针刺加神经阻滞组有效率和优良率显著高于针刺组和神经阻滞组(均P<0.01)。结论:神经阻滞和针刺是治疗腰椎间盘突出症的有效方法,两种方法联合应用疗效更佳。

Objective To investigate the therapeutic effects of acupuncture combined with nerve block for treatment of lumbar disc herniation. Methods Ninety cases of lumbar disc herniation were randomly divided into three groups： acupuncture combined with nerve block group, acupuncture group and nerve block group, 30 cases in each group. The acupuncture combined with nerve block group was treated with acupuncture combined with nerve block therapy, L2 --L5 Jiaji （EX-B 2）, Zhibian （BL 54）, Huantiao （GB 30）, Yanglingquan （GB 34） etc. were selected for acupuncture, affected nerve root, sciatic nerve or common peroneal nerve were selected for nerve block with anti-inflammation-analgesic injection; the acupuncture group was treated with acupuncture only; the nerve block group was treated with nerve block only. After 4 weeks of treatment, the visual analogue scale （VAS）, Oswestry lumbar dysfunction index （ODI） and modified MacNab standard were compared to evaluate the therapeutic effects of three groups. Results The VAS and ODI in all groups were significantly decreased after one week, two weeks and four weeks of treatment （all P〈0. 01）; after one week of treatment, the scores of VAS and ODI in nerve block group and acupuncture combined with nerve block group were significantly lower than those of acupuncture group （P〈0.05） ; after two weeks and four weeks of treatment, the scores of VAS and ODI in acupuncture combined with nerve block group were significantly lower than those of acupuncture group and nerve block group （P〈0.05）. The effective rate and excellent and good rate of the acupuncture combined with nerve block group were significantly higher than those of acupuncture group and nerve block group （both P〈0. 01）. Conclusion The nerve block thera- py and acupuncture are effective methods for treatment of lumbar disc herniation, while it has a better effect when these two treatments are combined used.