针刀对腰椎间盘突出症患者经皮椎间孔镜术后腰段多裂肌脂肪浸润程度的影响

Effect of acupotomy on the fat infiltration degree of lumbar multifidus muscle in patients with lumbar disc herniation after percutaneous transforaminal endoscopic discectomy

目的:观察针刀对腰椎间盘突出症患者经皮椎间孔镜术(PTED)后腰段多裂肌(LMM)脂肪浸润程度的影响。方法:将104名接受PTED治疗的腰椎间盘突出症患者随机分为观察组(52例,脱落3例)和对照组(52例,脱落4例)。两组患者均于PTED治疗48 h后开始接受两周的康复训练,观察组患者术后24 h内进行1次针刀(L3~L5夹脊穴)治疗。比较两组患者术前、术后6个月LMM脂肪浸润横截面积(CSA),观察两组患者术前及术后1、6个月视觉模拟量表(VAS)评分和Oswestry功能障碍指数(ODI)评分,并对各节段LMM脂肪浸润CSA与VAS评分进行相关性分析。结果:术后6个月,观察组患者L4/L5及L3~S1总体节段LMM脂肪浸润CSA较术前降低(P<0.05),观察组患者L4/L5节段LMM脂肪浸润CSA低于对照组(P<0.01)。术后1个月,两组患者ODI、VAS评分均较术前降低(P<0.01),且观察组低于对照组(P<0.05);术后6个月,两组患者ODI、VAS评分均较术前、术后1个月降低(P<0.01),且观察组低于对照组(P<0.01)。两组患者术前L3~S1总体节段LMM脂肪浸润CSA与VAS评分呈正相关(r=0.64,P<0.01);术后6个月,两组患者各节段LMM脂肪浸润CSA与VAS评分均无相关性(P>0.05)。结论:针刀能够改善腰椎间盘突出症患者PTED后LMM脂肪浸润程度、疼痛症状和日常生活活动能力。

Objective To observe the effect of acupotomy on the fat infiltration degree of lumbar multifidus muscle(LMM)in patients with lumbar disc herniation after percutaneous transforaminal endoscopic discectomy(PTED). Methods A total of 104 patients with lumbar disc herniation treated with PTED were randomly divided into an observation group(52 cases,3 cases dropped off) and a control group(52 cases, 4 cases dropped off). Patients of both groups received rehabilitation training of two weeks 48 h after PTED treatment. The observation group was treated with acupotomy(L3-L5 Jiaji [EX-B 2])once within 24 h after PTED. In the two groups, the fat infiltration cross sectional area(CSA) of LMM was compared before and 6 months after PTED, the visual analogue scale(VAS) score and Oswestry disability index(ODI) score were observed before and 1, 6 months after PTED. The correlation between fat infiltration CSA of LMM in each segment and VAS score was analyzed. Results Six months after PTED, the fat infiltration CSA of LMM in L4/L5 and the total L3-S1segments of the observation group was lower than that before PTED(P<0.05), and the fat infiltration CSA of LMM in L4/L5 of the observation group was lower than the control group(P<0.01). One month after PTED, the ODI and VAS scores of the two groups were lower than those before PTED(P<0.01), and those in the observation group were lower than the control group(P<0.05). Six months after PTED, the ODI and VAS scores of the two groups were lower than those before PTED and 1 month after PTED(P<0.01), and those in the observation group were lower than the control group(P<0.01). There was a positive correlation between the fat infiltration CSA of LMM in the total L3-S1 segments and VAS scores in the two groups before PTED(r = 0.64, P<0.01). Six months after PTED, there was no correlation between the fat infiltration CSA of LMM in each segment and VAS scores in the two groups(P>0.05). Conclusion Acupotomy can improve the fat infiltration degree of LMM, pain symptoms and activities of daily living in patients with lumbar disc herniation after PTED.