两种定位方法对体外冲击波治疗腰脊神经后支综合征疗效的影响

The curative effects of extracorporeal shock wave treatment applied in two orientations on lumbar ramus posterior nervorum spinalium syndrome

目的比较X线定位与痛点定位体外冲击波治疗腰脊神经后支综合征的临床治疗效果。方法选择腰脊神经后支综合征患者60例，按随机数字表法分为X线定位组30例和痛点定位组30例，分别进行X线定位体外冲击波治疗与痛点定位体外冲击波治疗，2组患者分别于治疗前和第1、2、3次治疗后采用Greenough等推荐的75分腰功能量化指标（腰功能量化评分）进行评分，并评价其疗效。结果治疗前，2组患者的腰功能量化评分差异无统计学意义（P〉0．05）。第1、2、3次治疗后，2组患者的腰功能量化评分与组内治疗前比较，差异均有统计学意义（P〈0．01）。第1次治疗后，2组患者腰功能量化评分组间比较差异无统计学意义（P〉0．05），第2、3次治疗后，X线定位组的腰功能量化评分分别为（48．17±5．40）分和（66．00±8．59）分，与痛点定位组的（43．30±6．84）分和（57．87±10．52）分比较，差异均有统计学意义（P〈0．01）。治疗3次后，X线定位组的治愈率和治愈显效率分别为76．7％和93．3％，明显高于痛点定位组的33．3％和76．7％，组间差异均有统计学意义（P〈0．01）。结论X线定位体外冲击波治疗腰脊神经后支综合征具有定位准确、疗效显著等优点，且疗效显著优于痛点定位体外冲击波疗法。

Objective To compare the clinical effects of extracorporeal shock wave treatment （ESWT） on lumbar ramus posterior nervorum spinalium syndrome and to compare the effectiveness of applying it in X-ray orien- tation with pain-point orientation. Methods Sixty patients with lumbar ramus posterior nervorum spinafium syndrome were randomly divided into an X-ray orientation group and a pain-point orientation group with 30 subjects in each group. The two groups then received ESWT with the X-ray orientation and pain-point orientation, respectively. The ESWT was delivered at the energy of 0.12 to 0.20 mJ/cm^2 and the frequency of 60-80 pulses per minutes. A total of 1000-1500 shock wave pulses were delivered every time. Three sessions of ESWT were administered, with a 3-5 days of interval between each session. The results were rated using the 75 scores of the lumbar function quan- tification index recommended by Greenough. Ratings were done before treatment, and after the first, the second and the third treatment. Results There was no significant difference between the groups＇ average index scores before treatment. There were however significant differences from the baseline scores after the first, the second and the third treatments. There was no significant difference in average lumbar function quantification scores between the groups after the first treatment, but the inter-group differences were statistically significant after the second and the third treatments. After three treatments the cure rate in the X-ray orientation group was 76.7% and overall effectiveness was 93. 3%. Both were significantly higher than in the pain-point orientation group （33. 3% and 76.7% respectively）. Conclusions The advantages of X-ray orientation when administering ESWT for lumbar rami posterior nervorum spinalium syndrome are more exact positioning and more effective treatment. The effect was obviously better than with pain-point orientation.