选择性神经根阻滞术配合理筋正骨手法治疗腰椎间盘突出症临床观察

Clinical Observation of Selective Nerve Root Block Combined with Reasonable Tendon Setting Manipulation in the Treatment of Lumbar Intervertebral Disc Herniation

目的:观察选择性神经根阻滞术配合理筋正骨手法治疗非手术型腰椎间盘突出症的临床疗效。方法:选择2019年10月—2020年12月在安徽中医药大学第一附属医院骨伤一科接受保守治疗的腰椎间盘突出症患者60例。采用随机数表法分为观察组、手法组、封闭组,每组20例。观察组运用选择性神经根阻滞术后配合理筋正骨手法治疗,手法组仅接受理筋正骨手法进行治疗,封闭组仅接受选择性神经根阻滞术进行治疗。采用视觉模拟评分法(VAS)及日本骨科协会评估治疗分数(JOA)观察3组患者经治疗后腰部和腿部疼痛改善情况及腰椎功能改善情况。结果:治疗前后VAS评分比较显示,3组治疗后VAS评分均有明显降低且观察组治疗后VAS评分明显低于封闭组与手法组,差异具有统计学意义;3组患者治疗前后JOA评分比较显示,3组患者经治疗后JOA评分均有明显提高,观察组治疗后JOA评分明显高于手法组及封闭组,差异具有统计学意义。结论:选择性神经阻滞书与理筋正骨手法,2种治疗手段相互配合,取长补短,对于相对简单的腰间盘突出患者具有更好的临床疗效。

Objective:To observe the clinical efficacy of selective nerve root block surgery combined with reasonable muscle and bone orthopedic manipulation in the treatment of non-surgical lumbar disc herniation.Methods:From October 2019 to December 2020,60 patients with lumbar disc herniation who received conservative treatment in the Department of Orthopedics and Traumatology,the First Affiliated Hospital of Anhui University of Traditional Chinese Medicine were selected.Using random number table method,they were divided into observation group,manipulation group,and closed group,with 20 cases in each group.The observation group was treated with selective nerve root block with reasonable muscle and bone setting technique,the manipulative group received only the tendon and bone setting technique for treatment,and the closed group only received selective nerve root block.The visual analogue scale (VAS) and the Japanese Orthopedic Association Assessment Treatment Score (JOA) were used to observe the improvement of lumbar and leg pain and the improvement of lumbar spine function after treatment in the 3 groups.Results:The comparison of VAS scores before and after treatment showed that the VAS scores of the 3 groups were significantly reduced after treatment,and the VAS scores of the observation group after treatment were significantly lower than the closed group and the manual group,the difference was statistically significant;the comparison of the JOA scores of the 3 groups before and after treatment showed The JOA scores of the 3 groups of patients were significantly improved after treatment,and the JOA scores of the observation group were significantly higher than the manual group and the closed group after treatment,and the difference was statistically significant.Conclusion:The selective nerve block book and the manipulation of tendons and bones,the two treatment methods cooperate with each other,and learn from each other’s strengths to make up for the weaknesses,and have a better clinical effect for patients with relatively simple lumbar disc herniation.