侧隐窝入路硬膜外注射脉络宁复合液治疗腰椎间盘突出症的临床研究

Clinical Study on Lumbar Disc Herniation Treated with Lateral Recess Epidural Injection of Mailuoning Mixture

目的观察侧隐窝入路硬膜外注射脉络宁复合液治疗腰椎间盘突出症的临床疗效。方法选择2013年3月~2016年5月腰椎间盘突出症患者204例,随机分为侧隐窝入路组(A组)与正中入路组(B组),每组102例。两组所用药物均为脉络宁复合液,治疗1次/周,4次为1个疗程。分别在治疗前,治疗1周、2周、3周、4周、6个月后,采用视觉模拟评分法(visual analogue scale,VAS)进行疼痛评分,同时记录两组治疗过程中直腿抬高试验的变化及治疗后不良反应。结果两组患者侧方突出与中央型突出VAS评分,治疗后均较治疗前有明显的降低,差异有统计学意义(P<0.01)。临床治愈率A组58.82%明显优于B组的18.63%,差异有统计学意义(P<0.01)。6个月后随访,临床治愈率两组均有进一步提高,侧隐窝入路效果更好,两组比较差异有统计学意义(P<0.01)。结论侧隐窝入路硬膜外注射脉络宁复合液,治疗不同类型的腰椎间盘突出症临床疗效显著。该方法明显优于后正中入路组,而且见效快,远期疗效好,是治疗腰椎间盘突出症的重要手段之一。

Objective To observe the clinical therapeutic effects on lumbar disc herniation treated with lateral recess epidural injection of mailuoning mixture.Methods From March 2013 to May 2016,204 cases of lumbar disc herniation were randomized into a lateral recess injection group（A group）and a posterior media injection group（B group）,102 cases in each one.Mailuo ning mixture was used in the two groups,once a week,4 treatments as 1 session.Separately,before treatment and 1,2,3 and 4 weeks as well as 6 months after treatment,VAS score was observed.The Lasegue test and adverse reactions were recorded during the treatment in the two groups.Results VAS scores were all reduced apparently after treatment as compared with those before treatment in the lateral herniation and central herniation cases,indicating the significant difference（P〈0.01）.The clinical curative rate in the A group was 58.82%,apparently better than 18.63% in the B group,indicating the significant difference（P〈0.01）.In the follow-up after 6 months,the clinical curative rate was further improved in the two groups.The effects with the lateral recess injection were much better.The difference was significant between the two groups（P〈0.01）.Conclusion The lateral recess epidural injection of mailuoning mixture achieves the significant clinical therapeutic effects on lumbar disc herniation of different types.This method is obviously better than that in the posterior median injection group.It achieves the effects quickly and has a good long-term therapeutic result and it is one of the important approaches to the treatment of lumbar disc herniation.