经皮激光汽化减压术联合中药离子导入治疗腰椎间盘突出症(附30例报告)

Clinical Efficacy to Treat Lumbar Disc Herniation Jointly with Percutaneous Laser Disc Decompression and Chinese Medicine Iontophoresis( A Report on 30 Cases)

目的观察经皮激光汽化减压术(percutaneous laser disc decompression,PLDD)联合中药离子导入治疗腰椎间盘突出症(lumbar disc herniation,LDH)的临床疗效。方法回顾性分析2012年1月至2015年12月,LDH患者30例的临床资料,男性22例,女性8例,年龄30~70岁,平均50.3岁。激光治疗能量600~1 000 J/椎间盘。患者在PLDD治疗后7 d行中药离子导入治疗。术前、术后1、3、6和12个月采用改良的Macnab评价、疼痛视觉模拟评分法(visual analogue scale,VAS)评分和Oswestry功能障碍指数(oswestry disability index,ODI)评分判定患者术后临床疗效和不良反应发生情况。同时,观察年龄≤50岁组和>50岁组的临床疗效。结果 30例患者治疗后均有不同程度的症状改善,术后12个月的临床优良率为83.3%,VAS和ODI评分较术前明显下降,与术后1个月比较差异有统计学意义(P<0.05)。年龄≤50岁组和>50岁组,两组的临床优良率比较无统计学意义(P>0.05)。结论 PLDD联合中药离子导入治疗LDH短期内能够有效缓解疼痛、麻木等临床症状,是一种有效的治疗手段。

Objective To observe the effect of combined application of percutaneous laser disc decompression （PLDD） and Chinese medicine ion- tophoresis on lumbar disc herniation（LDH）.Methods A retrospective analysis was made on 30 patients having received PLDD from Jan. 2012 to Dec. 2015. They were treated jointly with PLDD and Chinese medicine iontophoresis. They were aged from 30 to 70 years （ mean 50. 3 years） , including 22 males and 8 females. The total energy adopted in the treatment was 600-1 000 J/disc. The patients were given Chinese medicine iontophoresis after the PLDD treatment for 7 days. After the treatment, the patients were followed up at month 1, 3, 6 and 12. The curative effect was evaluated with modified of Macnab criteria, pain level with visual analogue scale （VAS） and lumbar functions with Oswestry disa- bility index questionnaire （oswestry disability index, ODI）. The patients were divided into two groups： age ≤ 50 group and age 〉 50 group. The efficacy between the groups was compared, and the complications were also reviewed. Results Based on the evaluation with modified of Macnab criteria, the clinical efficiency was 83.3% 12 months after the treatment. The ODI scores and VAS pain scores 12 months after the operation were significantly lower than those 1 month after the operation, and the differences were statistically significant （ P 〈 0. 05）. The difference between patients less than 50 years old and those over 50 years was not statistically significant （ P 〉 0.05 ）. No complication was noted in any patient. Conclusions Being effective and stable, combined application of PLDD and Chinese medicine iontophoresis is an ideal treatment for lumbar disc herniation.