中医药对腰椎间盘突出症经皮椎间孔镜术后残留腰痛的治疗进展

A review on treating residual low back pain in lumbar disc herniation patients after percutaneous transforaminal endoscopic discectomy in TCM

腰椎间盘突出症(Lumbar Disc Herniation,LDH)是临床常见的骨科疾病,相关流行病学调查显示,LDH的发病率高达14.3%。随着近年来人们生活方式的改变以及我国人口老龄化的加剧,LDH发病率呈逐年上升趋势,并且有趋于年轻化的现象。本病有起病急、症状重、复发率高的特点,极大影响患者的日常生活和工作。LDH的临床治疗分为保守治疗和手术治疗,在临床诊疗中,多数患者往往优先选择保守方式进行治疗,且80%~85%的患者可通过保守方式获得良好的治疗效果,经严格保守治疗疗效不佳者可采取手术治疗。根据适应证,手术可选择传统开窗手术以及经皮椎间孔镜手术。随着科技的进步与人们对脊柱疾病认识的进一步加深,腰椎孔镜技术获得了突飞猛进的发展,其在治疗LDH上相对于传统的开放术式具有手术创伤小、术中出血量少、术后恢复快等优点。但是随着孔镜手术的普遍开展,临床上发现不少患者行孔镜手术后仍会残留腰痛症状,对于该种腰痛,西医治疗以对症止疼为主;而中医应用中药内服、中药外用、针灸等手段治疗该病,具有不良反应小、治疗方法多样且疗效显著等优势。现将中医药对LDH孔镜术后残留腰痛的临床治疗进展进行归纳总结,为临床医师在治疗腰椎孔镜术后残留腰痛方面提供参考。

Lumbar disc herniation(LDH) is a common orthopedic disease in clinic. Relevant epidemiological investigations show that the incidence of LDH is as high as 14.3%. With the change of people’s lifestyle and the aggravation of population aging in China in recent years, the incidence of LDH is increasing year by year, and there is a tendency of younger incidence. The disease has the characteristics of acute onset, severe symptoms and high recurrence rate, which greatly affects the daily life and work of patients. The clinical treatment of LDH is divided into conservative treatment and surgical treatment. In clinical diagnosis and treatment, most patients often give priority to conservative treatment, and 80%-85% of patients can obtain good therapeutic effect through conservative treatment. Surgical treatment can be adopted if the curative effect of strict conservative treatment is not good. According to the indications, traditional fenestration and percutaneous transforaminal endoscopic discectomy can be selected. With the progress of science and technology and the further deepening of people’s understanding of spinal diseases, lumbar endoscopic technique has been developed by leaps and bounds. Compared with traditional open surgery, it has the advantages of less surgical trauma, less intraoperative blood loss and faster postoperative recovery in the treatment of LDH. However, with the widespread development of endoscopic surgery, it is found in clinic that many patients still have low back pain after endoscopic surgery. For this kind of low back pain, Western medicine treatment is mainly symptomatic pain relief. Traditional Chinese medicine has the advantages of small adverse reactions, various treatment methods and significant curative effect in treating the disease by oral administration of TCM medicine, TCM external application and acupuncture. This article summarizes the clinical progress of traditional Chinese medicine in the treatment of residual low back pain after percutaneous transforaminal endoscopic discectomy, so as to provide a reference for clinicians in the treatment of residual low back pain after percutaneous transforaminal endoscopic discectomy.