小针刀神经根管直接松解术治疗根性疼痛随机双盲对照临床研究

Clinical study of DNRCA in treating radiculopathy pain

目的评价"小针刀神经根管松解术"治疗根型颈椎病及腰突症的疗效、安全性。方法将根型颈椎病及腰突症各50例按分层随机双盲对照法分为治疗组及对照组,两组均予针灸、推拿、牵引及中药辨证论治,治疗组加载小针刀神经根管松解术,对照组加载小针刀神经根管假松解术。以无效、疗效不佳而要求结束试验为观察终点,试验中进行症状体征积分及MPQ量表评定、不良事件调查并记录,并随访半年。结果治疗组疗效均优于对照组(P<0.05),但总体治疗时间无显著差异(P>0.05),根型颈椎病治疗组小针刀操作中2例出现神经根损伤。腰突症治疗组不良反应较轻,发生率较低。结论小针刀神经根管松解术治疗腰突症具有显效快、疗效好、安全性高的优点,值得推广。而用于根型颈椎病虽总体疗效有一定优势,但其不良反应较重,潜在风险较高,尚需进一步探索更安全的技术方案。

Objective To study the effect and security of direct neurolysis on radicular canal with acupotomy （DNR- CA） treating the radicular type cervical spondylosis and lumbar disc protrusion. Methods All of 50 cases of the radic- ular type cervical spondylosis and 50 cases of the lumbar disc protrusion were separately randomly divided into two groups： the treatment group and the control group. On the basis of both groups were all treated with the acupuncture, massage, traction and the Traditional Chinese Drugs based on differentiation, the patients of the treatment group were treated with DNRCA but the control group with the pseudo aeupotomy. The study was end when the patients felt no effect or aggravated. All patients were evaluated with the cumulative score of the symptoms and signs （SS）, MPQ and adverse event during the treatment and visiting period. Return visit was lasted half a year after treatment. Results The effect of treatment group was obviously superior to that of the control group（P 〈 0.05）. The period of treatment had no significant difference between the two groups （P 〉 0.05 ）. Nerve damage had occurred in two cases of the radicular type cervical spondylosis treatment group but less adverse event had occurred in the lumbar disc herniation treatment group. Conclusion There was obviously better and faster efficacy as well as lower potential risk in the DNRCA treat- ing the lumbar disc protrusion, which was worth further spreading. But there were more adverse reactions and poten- tial risks in the radicular cervical spondylosis, which needed further improving even though its better efficacy.