侧隐窝及椎旁肌肉内注射臭氧治疗伴有间盘突出的急性下背痛的临床观察

Clinical Observation of Lumbar Lateral Recess and Paravertebral Intramuscular Injection of Oxygen-ozone in the Treatment of Acute Low Back Pain with Lumbar Disc Herniation

目的观察臭氧在侧隐窝联合椎旁肌肉内注射治疗伴有腰椎间盘突出的急性下背痛的临床效果。方法选取2014年6月至2015年6月期间伴有腰椎间盘突出的急性下背痛患者132例,随机分为实验组(A组)和对照组(B组)。入组患者均签署了知情同意书。首次治疗2组均在CT引导下进行病变部位的侧隐窝穿刺,A组注入3 m L臭氧(25μg/m L),B组注入3 m L甲泼尼龙琥珀酸钠(40 mg);同时在病变间盘相邻的两节腰椎旁肌肉内注射,A组每点注入5 m L臭氧(25μg/m L),B组每点注入5 m L利多卡因溶液(0.5%)。侧隐窝注射只做1次,椎旁肌肉内的注射需重复进行,每周3次,连续治疗3周。采用视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评价患者疼痛及腰椎功能情况,记录患者治疗前,治疗后15 d、30 d、3个月的VAS评分及ODI值。结果 132例患者均获得完整随访,A组治疗后各时间点VAS评分及ODI分值均低于术前及同时间段的对照组,差异均有统计学意义(P<0.05);A组在第30天随访时出现最好疗效并维持至随访结束。结论臭氧在侧隐窝联合椎旁肌肉内注射可以有效缓解伴有腰椎间盘突出的急性下背痛,值得临床推广应用。

Objective To assess the clinical effects of lumbar lateral recess and paravertebral muscle injection ozone in acute low back pain with lumbar disc herniation. Methods From June 2014 to June 2015, a random controlled clinical trial was carried out in 132 patients suffering acute low back pain with lumbar disc herniation. All patients were randomly divided into two groups ： study group （A） and control group （ B ）. For the first treatment, all patients received the puncture of lumbar lateral recess that was adjacent to the herniated disc under CT guidance. Patients of group A received 25 p^g/mL oxygen-ozone 3 mL, while group B patients received methylprednisolone 40 mg in 3 mL. Meanwhile, lumbar pamvertebral intra- muscular injections were performed. Patients in the A group received 5 mL of oxygen-ozone （25 μg/mL） each point, and patients in B group were ad- ministrated with 5 mL of 0.5% lidocaine each point .The procedure of paravertebml intramuscular injections were repeated 3 times per week for 3 weeks in both groups, while lateral recess injections was performed only once at the frrst time in all patients. The improvement of clinical symptoms were assessed with the visual analogue scale （VAS） scores and the oswestry disability index （ODI） in different periods. Resulls The whole 132 patients completed the trial. The VAS scores for group A were significantly lower than group B in different periods （P 〈 0.05 ）. The value of ODI was also siguifieantly lower than group B （P 〈 0.05 ）. The best curative effect of Group A was observed in day 30 and maintained until the end of follow- up. Conclusion The therapy of lumbar lateral recess combined paravertebml intramuscular injection of oxygen-ozone for patients suffering acute back pain with lumbar disc herniation is safe, effective, and worthy of clinical promotion.