超声引导下腰椎间盘突出注射配合核心肌群训练的疗效观察

Therapeutic Effect of Ultrasound-guided Lumbar Intervertebral Disc Herniation Injection Combined with Core Muscle Training

目的:比较单纯超声引导下腰椎间盘突出症注射治疗与注射术后配合核心肌群训练的疗效。方法:选取2016年6月-2019年12月康复科门诊腰椎间盘突出患者60例作为观察对象,所有患者均由CT或MRI确诊,且无手术指征,随机分为观察组和对照组,每组30例,均采用超声引导下注射,Lgn或L4s椎间盘突出采用椎间孔注射,Ls/S,椎间盘突出采用骶管注射.观察组术后第2天起加腰部核心肌群训练,每次30分钟,2次/d,连续4周。对照组仅注射治疗,2组均注射3次,每周注射1次,治疗时间共4周,并随访3个月及6个月,观察腰痛复发情况。观察治疗1周,3周及4周的优良率情况,2组治疗前与治疗后4周VAS评分及日本骨科协会评价治疗得分(J0A)、Oswestry功能障碍指数问卷调查(ODI)进行对比。3个月、6个月复发百分率。结果:2组治疗后VAS评分明显降低(P<0.05);其中,观察组治疗4周后VAS评分,与对照组的比较,差异明显(P<0.05);观察组4周后优良率高于对照组,差异明显(P<0.05);所有患者0DI指数较治疗前降低,而且观察组较对照组明显降低;J0A评分较治疗前提高,而且观察组比对照組升高明显(P<0.05)。3个月及6个月随访复发率明显降低。结论:超声引导下腰椎间盘突出注射配合核心肌群训练效果好,能减轻复发率,值得基层临床推广。

Objective:To compare the efficacy of simple ultrasound-guided lumbar intervertebral disc herniation injection with core muscle training after injection.Methods:selecting rehabilitation clinic of 60 patients with lumbar disc as research object,all the patients were diagnosed by CT or MRI,and no surgical indications,were randomly divided into observation group and control group,30 cases in each group,all use ultrasound guided by injection,L3/4 or L4/5 intervertebral disc herniation using intervertebral foramen injection,L5/SI intervertebral disc herniation using sacral canal injection,The observation group was added with lumbar core muscle training from the second day after surgery,30min each time,twice a day for 4 weeks,while the control group was only treated with injection,3 times in both groups,once a week,for a total of 4 weeks,and followed up for 3 months and 6 months to observe the recurrence of low back pain.The excellent and good rates at 1,3 and 4 weeks of treatment were observed,and VAS scores before and 4 weeks after treatment,JOA and Oswestry Disability Index questionnaire were compared.Percentage of relapse at 3 and 6 months.Results:VAS scores in both groups decreased significantly after treatment(P<0.05);The VAS score of the observation group was significantly different from that of the control group after 4 weeks of treatment(P<0.05).The excellent and good rate of the observation group was significantly higher than that of the control group after 4 weeks of treatment(P<0.05).ODI index of all patients was lower than before treatment,and the observation group was significantly lower than the control group.JOA score was higher in the observation group than in the control group(P<0.05).The recurrence rate of 3 months and 6 months follow-up decreased significantly.Conclusion:Ultrasound-guided injection of lumbar disc herniation combined with core muscle training has a good effect and can reduce the recurrence rate,which is worthy of clinical promotion at the basic level.