超声引导下PRP注射联合康复训练对CNLBP的影响

Effect of ultrasound-guided platelet-rich plasma injection combined with rehabilitation training on chronic non-specific low back pain

目的探讨富血小板血浆(PRP)联合康复训练对慢性非特异性下背痛(CNLBP)的治疗效果。方法将66例CNLBP患者分为PRP组及糖皮质激素(激素)组各33例。PRP组予以超声引导下PRP注射1次联合康复训练,激素组予以超声引导下激素注射1次联合康复训练。治疗前及治疗后1个月用简化Mc Gill疼痛问卷(SF-MBQ)进行疼痛评估,用Oswestry功能障碍指数(ODI)进行腰椎功能评估,用改良Barthel指数(MBI)评价日常生活能力,用表面肌电图(均方根、平均功率频率)进行腰背肌功能评定,并评估治疗后6个月内的复发率。比较2组的上述各项检测内容。结果在治疗过程中,2组各有3例因出现并发症而中途退出。治疗前2组患者SF-MBQ、MBI、ODI及表面肌电图的均方根与平均功率频率比较差异均无统计学意义(P均>0.05)。治疗后2组的SF-MBQ各项评分、ODI及表面肌电图的的均方根、平均功率频率均较治疗前低(P均<0.05),且PRP组均低于激素组(P均<0.05);2组的MBI评分均较治疗前高(P均<0.05),且PRP组高于激素组(P<0.05)。PRP组复发率为23%,低于激素组的67%(P<0.05)。结论 PRP联合康复训练对CNLBP的治疗效果优于激素联合康复训练。

Objective To evaluate the clinical efficacy of platelet-rich plasma(PRP) injection in combination with rehabilitation training in the treatment of chronic non-specific low back pain( CNLBP).Methods Sixty six CNLBP patients were divided into the PRP( n = 33) and glucocorticoid( hormone) groups(n = 33). In the PRP group,one cycle of ultrasound-guided PRP injection combined with rehabilitation training was delivered. In the hormone group,one cycle of ultrasound-guided hormone injection in combination with rehabilitation training was performed. Before and 1 month after treatment,short-form Mc Gill pain questionnaire(SF-MPQ) was adopted to evaluate the severity of pain. Oswestry dysfunction index(ODI) was utilized to assess the lumbar vertebral function. Modified Barthel index( MBI) was used to assess the daily life ability. Surface electromyography( root-mean-square and average power frequency) was utilized to evaluate the function of the low back muscle. The recurrence rate of CNLBP was assessed at 6 months after corresponding treatment.Relevant parameters were measured and statistically compared between two groups. Results During the therapeutic process,3 patients in each group withdrew from the study due to intolerable complications. Prior to treatment,no statistical significance was observed in the SF-MBQ,MBI,ODI and root-mean-square and average power frequency of surface electromyography between two groups( all P > 0. 05). In both groups,the SF-MBQ score,ODI and root-mean-square and average power frequency of surface electromyography after treatment were significantly lower compared with those before treatment( all P < 0. 05),and the values in the PRP group were significantly lower than those in the hormone group( all P < 0. 05). In both groups,the MBI scores after treatment were considerably higher than those prior to treatment( both P < 0. 05),and the MBI score in the PRP group was significantly higher compared with that in the hormone group( P < 0. 05). In the PRP group,the recurrence rate of CNLBP was 23%,significantly lower compared with 67% in the hormone group( P < 0. 05).Conclusion PRP injection in combination with rehabilitation training yields higher clinical efficacy compared with hormone therapy combined with rehabilitation training in treating CNLBP.