硬膜外腔导管松解治疗腰椎间盘突出症

Efficacy of percutaneous epidural adhesiolysis among patients with chronic low back and lower extremity pain secondary to lumbar disc herniation

[目的]探讨硬膜外腔导管松解、精确药物注射,治疗腰椎间盘突出症所致腰腿痛的临床疗效。[方法]2009年1月～2010年10月,收治腰椎间盘突出症患者88例,男48例,女40例;年龄25～72岁,平均(40.76±10.59)岁。所有患者分成两个治疗组,各44例。对照组(骶管组)采用单纯骶管注射治疗;观察组(导管组)采用经皮、经骶管入路,行硬膜外腔导管松解、精确药物注射。采用Oswestry功能障碍指数(oswestry disability index,ODI)、疼痛视觉模拟评分(visual analogue scale,VAS)评估患者术后疗效。[结果]88例均获得25～36个月的随访,平均(29.3±4.0)个月。对照组:ODI术前平均为(68.3±13.2)%,末次随访平均为(41.2±21.1)%;VAS评分术前平均为(6.6±1.2)分,末次随访平均为(3.9±2.1)分。观察组:ODI术前平均为(70.5±13.6)%,末次随访平均为(23.3±18.6)%;VAS评分术前平均为(6.7±1.2)分,末次随访平均为(2.1±1.6)分。末次随访时,两组Oswestry功能障碍指数(ODI)改善率差异具有统计学意义(P<0.05)。[结论]经皮、经骶管行硬膜外腔导管松解、精确药物注射,是可有效缓解腰椎间盘突出症所致腰腿痛症状的微创治疗方式。

[ Objective] To compare the efficacy of percutaneous epidural adhesiolysis with that of fluoroscopically directed caudal epidural injections among patients with chronic low back and lower extremity pain secondary to lumbar disc herniation.[ Methods ] Patients （ n = 88） were randomly assigned to 2 groups of 44 patients each. The patients in the control group re- ceived caudal epidural injections with catheterization up to the third sacral vertebra （S3） under local anesthesia. Patients in the treatment group underwent percutaneous epidural adhesiolysis with targeted drug delivery. Clinical outcomes were evaluated using the Oswestry Disability Index （OD1） and the visual analogue scale （VAS） before operation and at the last follow- up examina- tion after treatment. [Results] The 88 patients were followed up for 25 - 36 months （ mean, 29.3 ± 4. 0 months） . In the control group, the mean ODI scores before operation and at the last follow -up examination were （68.3± 13.2）% and （41.2±21.1 ）%, respectively, and the mean VAS scores were （6. 6±1.2） and （3.9 ±2. 1 ）, respectively. In the treatment group, the mean ODI scores before operation and at the last follow - up examination were （70. 5±13.6） % and （ 23.3 ±18.6） % , re- spectively, and the mean VAS scores were （6. 7±1.2） and （2. 1±1.6）, respectively. According to the ODI, the recovery rate of the patients in the treatment group was significantly different （ P 〈 0.05 ） from that of the patients in the control group at the last follow - up examination. [ Conclusion ] Percutaneous epidural adhesiolysis may be effective in patients with chronic low back and lower extremity pain secondary to lumbar disc herniation.