弧刃针刀综合疗法治疗腰椎间盘突出症的临床研究

Clinical Study on Treatment of Lumbar Disc Herniation by Arc Edge Needle-scalpel Comprehensive Therapy

目的观察弧刃针刀综合疗法治疗腰椎间盘突出症(lumbar disc herniation,LDH)的疗效,探讨其作用机制。方法将76例LDH患者随机分为传统针刀组和弧刃针刀组,每组38例。传统针刀组给予传统针刀,弧刃针刀组给予弧刃针刀综合疗法,均治疗4周。治疗期间刀口线与脊柱平行刺入,以避免大量肌纤维组织受损,针刀刺入达骨面即止,注意避开重要血管。观察两组患者治疗前后及随访3个月日本骨科协会腰疼痛评分量表(JOA)、Oswestry功能障碍指数问卷评分量表(ODI)和视觉模拟(VAS)评分的变化;检测两组治疗前后及随访3个月血清IL-6、C-反应蛋白(CRP)和超氧化物歧化酶(SOD)的含量;比较两组有效率、随访12个月复发率及不良反应发生率。结果传统针刀组完成33例,弧刃针刀组完成35例。弧刃针刀组总有效率[97. 1%(34/35)]高于传统针刀组[81. 8%(27/33),χ2=8. 891,P=0. 027]。与本组治疗前比较,治疗后及随访3个月两组患者JOA评分和SOD含量升高(P <0. 05,P <0. 01),ODI、VAS评分和IL-6、CRP含量降低(P <0. 05,P <0. 01),且弧刃针刀组优于传统针刀组(P <0. 05,P <0. 01)。治疗后3个月和12个月的随访中,弧刃针刀组复发率均低于同期传统针刀组(χ2=9. 357,P=0. 004;χ2=12. 863,P=0. 002)。治疗过程中传统针刀组出现1例局部皮肤红肿、化脓、伤口难于愈合,经对口服抗生素及换药处理后症状好转。传统针刀组出现3例、弧刃针刀组出现1例皮下瘀青,经对症热敷后消失,其他未见明显不良反应。结论弧刃针刀综合疗法融合"针"、"刀"、"线"和"药物注射"四种功能于一体,可明显改善LDH患者的临床症状和血清IL-6、CRP、SOD含量。

Objective To observe the clinical effects of arc edge needle-scalpel( AENS) comprehensive therapy in treating lumbar disc herniation( LDH) and explore its mechanism. Methods Totally 76 LDH patients were assigned to the traditional needle-scalpel group and the AENS group,38 cases in each group. The traditional needle-scalpel was administered to patients in the traditional needle-scalpel group. Patients in the AENS group received AENS comprehensive therapy.The treatment course was 4 weeks for all. In order to avoid the damage of a large number of muscle fiber tissues,needle knife insertion should be stopped when it reaches the bone surface. Attention should be paid to avoid important blood vessels. The Japanese Orthopaedic Association( JOA),the Oswestry Disability Index( ODI) and Visual Analogue Scale( VAS) were observed in the two groups before and after treatment and 3-month follow-up. The content of interleukins-6( IL-6),C-reactive protein( CRP) and superoxide dismutase( SOD) were detected in the two groups before and after treatment and 3-month follow-up. The effectiverate,recurrence rate at 12-month follow-up and incidence of adverse reactions in the two groups were compared. Results Finally 33 cases in the traditional needle-scalpel group completed the trial,and 35 cases in the AENS group completed treatment. The total efficiency rate was 97. 1%( 34/35) in the AENS group,which was better than 81. 8%( 27/33) in the traditional needle-scalpel group( χ2= 8. 891,P = 0. 027). Compared with before treatment,the JOA score and SOD content were decreased(P < 0. 05,P < 0. 01),the ODI,VAS score and the IL-6 CRPcontent were decreased(P < 0. 05,P < 0. 01) in the two groups,and the AENS group was better than the traditional needle-scalpel group(P < 0. 05,P < 0. 01) after treatment and 3-month follow-up. The recurrence rate of the AENS group was lower than that in the traditional needle-scalpel group at the end of the 3 rd and 12 th month follow-up( χ2= 9. 357,P = 0. 004;χ2= 12. 863,P = 0. 002). During the treatment,local skin redness,maturation,and poor healing wound occured in 1 case of the traditional needle-scalpel group,symptoms improved after treatment with oral antibiotics and replacement. Subcutaneous bruising occured in 3 patients of the traditional needle-scalpel group and 1 patient in the AENS group. After the hot application of the disease disappeared,no other obvious adverse reactions were observed.Conclusion AENS comprehensive therapy was integrated by " needle", " scalpel ", " embedded wire " and " drug injection",and it could improve the clinical symptoms,the serum IL-6,CRP,SOD content of LDH patients.