经后、侧后入路臭氧治疗腰椎间盘突出症所致疼痛的对比研究

Analgesia of Percutaneous Medical Ozone Injection Through Posterior Route and Posterior-Lateral Route in Treatment of Lumbar Disc Herniation:A Comparative Study

目的对比研究经后、侧后入路穿刺臭氧治疗腰椎间盘突出症的镇痛效果。方法 253例满足研究条件的腰椎间盘突出症患者随机分为两组,分别采用后入路(A组,136例)及侧后入路(B组,117例)途径穿刺病变椎间盘并注射医用臭氧。前者注射位置为盘内、突出髓核内及突出部神经根周围,后者注射位置为盘内及椎间孔附近椎旁间隙。术前和术后3个月收集调查问卷和/或通过电话调查完成所需数据采集。主要数据包括下肢根性痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)评分、SF-36量表评分及其手术前后的改变,并做统计学处理。结果 253例患者均按预想成功实施臭氧注射治疗。两组患者除手术部位差异有统计学意义(P<0.05)外,在年龄、性别比例、病程长短、椎间盘突出程度等方面差异均无统计学意义(P>0.05)。从下肢疼痛VAS评分、ODI评分及SF-36量表评分三方面考察,两组患者均有显著治疗效果(P=0.000),而手术前、后VAS及ODI评分改变,A组明显大于B组(均示P=0.000),SF-36量表评分中躯体疼痛(BP)维度变化A组明显大于B组(P=0.018)。治疗优良率A组为90.4%,B组为81.2%,差异有统计学意义(P=0.034),且A组的显效率为41.9%,B组为27.4%。疗效优良的患者疼痛消退至VAS评分5以下的平均时间A组[(15±5)天]小于B组[(19±11)天](P=0.001)。结论相对于侧后入路穿刺途径,后入路穿刺途径治疗腰椎间盘突出症患者镇痛效果较高,疼痛减轻程度较大,疼痛消退速度较快,可根据实际情况选用。

Objective To compare the analgesia effect of percutaneous ozone injection through posterior route and pos-terior-lateral route in the treatment of lumbar disc herniation. Methods According to inclusion criteria specifying for this study, 253 candidates with lumbar disc herniation were enrolled into the study and were divided randomly into two treatment groups. Group A included 136 cases and performed posterior percutaneous ozone injection targeting the affected lumbar discs, protruded nucleus pulposus and space around the nerve root. Group B included 117 cases and performed posterior lateral route targeting the affected lumbar discs and the paraspinal space adjacent to the interveterbral foramen. Data collec- tion was done before and 3 months after treatment by questionnaire and/or telephone survey. The main required data includ- ed VAS pain score, ODI score and SF-36 score and the changes of all the scores between pre-and post-treatment. All above data was analyzed statistically. Results All 253 cases of patients with lumbar disc herniation were treated with percutane-ous ozone injection successfully. All baseline status （age, sex, duration of leg pain and height of discal protrusion） had no statistical difference between two treatment groups except for the route of injection. Apparent analgesia effect was found in both two treatment groups（ all P = 0. 000） assessed using the VAS score, ODI score and the SF-36 score. The changes of VAS score and ODI score of post-and pre-treatment had statistical different between two groups （both P = 0.000）, but only the change of BP dimension in SF-36 score of post-and pre-treatment showed significant difference between two groups（ P = 0.018 ）. There was statistical different of analgesia effect between two groups （ P = 0. 034, 90.4% of successful rate and 41.9% of excellent in group A and 81.2% of successful rate and 27.4% of excellent in group B respectively） . For the patients with excellent and good effect, the duration of leg pain reduction （under 5 assessed by VAS scale） in group A（ 15 ± 5 d） was shorter than that in group B （ 19 ± 11 d） （ P = 0.001 ）. Conclusion Posterior route injection for treating lumbar disc herniation was superior to posterior-lateral route with higher analgesia effect, more significant and faster reduction of leg pain. They should be selected according to the patient＇s condition and the operator＇s habit.