硬膜外封闭联合手法治疗LDH的疗效与CT定位区域的关系

Relationship between the Efficacy of Epidural Block Combined with Manipulation Treating for LDH and the Regional Location of Imaging

目的:探讨在硬膜外封闭基础上加用直腿抬高手法治疗腰椎间盘突出症(LDH)的适应症,以及不同CT定位区域的疗效差异性。方法:对2014年6月至2016年6月在本院就诊的腰推间盘突出症患者,根据诊断标准和排除标准选择60例,采用胡有谷影像学区域定位法分类,各区域术前及术后采用Macnab标准评定疗效、VAS评分和JOA评分,回顾性分析60例腰椎间盘突出症患者的治疗效果。结果:临床治疗效果采用Macnab标准,当腰椎间盘突出位置位于Ⅰ层、1-2区、a-b域,其疗效明显高于其余的区域,差异有统计学意义(P<0.05)。各区域术前及术后经VAS评分和JOA评分发现:Ⅰ层、1-2区、a-b域和Ⅱ-Ⅲ层、3-4区、c-d域之间存在差异,且差异有统计学意义(P<0.05)。结论:在硬膜外封闭基础上加用直腿抬高疗法在治疗腰椎间盘突出症方面有一定的疗效,而按照胡有谷区域定位法分类,当腰椎间盘突出物位于Ⅰ层、1-2区和a-b域时,本治疗方法能取得更佳的疗效。

Objective：To explore the indications of straight leg raising method on the basis of epidural block treating for lumbar disc herniation and the differences of therapeutic effect in different CT locating areas.Methods：From June 2014 to June 2016,60 patients with lumbar disc herniation in our hospital were selected according to the diagnostic criteria and the exclusion criteria,and the patients were classified by Hu Yougu imaging localization method.The therapeutic effect of 60 patients with lumbar disc herniation was retrospectively analyzed by Macnab standard,VAS score and JOA score before and after operation of each area.Results：The Macnab standard was used for the effect of the clinical treatment,when the lumbar disc herniation was located in theⅠlayer,1-2region,a-b domain,the curative efficiency was significantly higher than that of the rest of the region,the difference was statistically significant.The VAS and JOA score of the preoperative and postoperative in each region were found to be different between the Ⅰ layer,1-2region,a-b domain and theⅡ-Ⅲlayer,3-4region and c-d domain,and the difference was statistically significance.Conclusion：In the epidural block combined with straight leg raising therapy are effective in the treatment of lumbar disc herniation,and according to the Hu Yougu regional positioning method,when the classification of lumbar disc herniation is in theⅠlayer,1-2region and ab domain,the treatment in this study can obtain better curative effect.