脊神经后内侧支阻滞联合针刀松解治疗退行性腰椎滑脱症患者腰腿痛的疗效

Posteriomedian ramus of spinal nerve block combined with acupotomy lysis in the treatment of lumbago and leg pain caused by degenerative lumbar spondylolisthesis

目的 比较脊神经后内侧支阻滞加针刀松解与硬膜外阻滞治疗退行性腰椎滑脱症患者腰腿痛的疗效.方法 退行性腰椎滑脱症腰腿痛患者46例,随机均分为A、B两组,A组采用脊神经后内侧支阻滞加针刀松解,B组采用硬膜外阻滞,注射药物种类、剂量与A组相同.两组患者均治疗2次,1次/10d,2次1疗程.记录治疗前与治疗后24 h、2周、1个月、6个月、12个月时患者VAS值.于治疗后12个月行改良MacNab评价疗效.结果 与治疗前比较,所有患者治疗后24 h的VAS明显降低（P＜0.05）,治疗后2周～12个月腰痛的VAS明显降低（P＜0.05）,而腰痛伴腿痛的VAS差异无统计学意义（P＞0.05）.A组患者优良率73.9％（17/23例）高于B组39.1％（8/23例）（P＜0.05）.结论 脊神经后内侧支阻滞加针刀松解是治疗退行性腰椎滑脱症患者腰痛的有效方法.

Objective To compare and evaluate the efficacy of posteriomedian ramus of spinal nerve block and acupotomy lysis with epidural blockade in the treatment of lumbbago and leg pain caused by degenerative lumbar spondylolisthesis.Methods Forty-six patients with lumbbago and leg pain caused by degenerative lumbar spondylolisthesis were randomly divided into group A and group B, 23 cases in each group.Patients in group A received posteriomedian ramus of spinal nerve block combined with acupotomy lysis, and patients in group B received epidural block with same drugs and doses injected in group A, 1 time per 10 d and 2 times for a course.VAS was recorded before and at 24 h, 2 weeks, 1 month, 6 months and 12 months after treatment.The effect was evaluated with modified MacNab method at 12 months after treatment.Results Compared with pretreatment, VAS at 24 h after the treatment was significantly decreased in all patients（P〈 0.05）.VAS was significantly decreased （P 〈 0.05） in low back pain at 2 weeks-12 months after treatment, but V AS had no obvious difference（P〉 0.05） between the two groups in patients with low back and leg pain.The excellent and good rate in group A was 73.9% （17/23 cases） , which was higher than that in group B 39.1% （8/23 cases）（P〈 0.05）.Conclusion Posteriomedian ramus of spinal nerve block combined with acupotomy lysis is an effective method in the treatment of lumbago pain, but not combined leg pain caused by degenerative lumbar spondylolisthesis.