慢性骨筋膜室综合征所致慢性腰痛的临床诊断、治疗与康复

Clinical study of the chronic lumbar pain induced by chronic compartm ent syndrome

目的 探讨由腰骶部慢性骨筋膜室综合征所致慢性腰痛的临床诊断、手术治疗和康复方法。方法 对慢性腰痛患者采用临床检查、腰骶部竖脊肌骨筋膜室内压测量方法诊断为慢性骨筋膜室综合征者3 9例 ,其中男 17例 ,女 2 2例 ;年龄 18～ 66岁 ,平均 40 .6岁 ;慢性腰痛时间 2～ 42年 ,平均 2 5 .5年。采用微创方法行腰骶部竖脊肌骨筋膜室切开减压术 ,术后 2d开始进行腰、腹肌功能训练。结果 治疗后腰痛临床症状较术前明显好转、步行能力明显增加 ,腰部前屈、后伸活动度较术前分别增加 (15± 0 .5 )°和 (7± 0 .7)° ,腰骶部骨筋膜室内压在静息、运动中和运动后 6min以内 ,统计结果分别为 (6.6± 0 .7) ,(160 .3± 11.15 )和 (6.9± 0 .8)mmHg[术前分别为 (11.1± 0 .7) ,(188.1± 12 .0 8)和 (14 .1± 1.2 )mmHg] ,两组相比较差异均有统计学意义 (P <0 .0 5 )。超声多普勒表明腰骶部骨骼肌内最大血流速度和平均血流速度较术前分别增加 (0 .17± 0 .0 2 )和 (0 .0 9± 0 .0 1)kHz。结论 应用临床检查及骨筋膜室内压测定的方法诊断由腰骶部慢性骨筋膜室综合征所致慢性腰痛是可靠的。治疗上可采用骨筋膜室切开减压术。术后腰。

Objective To study the methods of clinic al diagnosis and treatment of chronic lumbar pain induced by chronic compartment s yndrome. Methods Thirty-nine patients with chronic lumbar pain induced by chronic compartment syndrome were recruited. Their diagno sis was confirmed by physical examination and measurement of of lumbar muscle in tra-compartment pressure. Micro-invasive opening decompression of the lumbar c ompartment was performed for treating these patients. Therapeutic exercises of t he lumbar and abdomen muscles were administered 2-days after operation. Results After treatment, the symptoms were significantly r elieved, distance of walk in creased as compared with those before operation. Th e ranges of trunk flexion and extension were increased. A comparison with the pr etreatment showed that the lumbar muscle intra-compartment pressures at rest du ring movement and 6 min after movement were decreased(6.6±0.7 vs 11.1±0.7),(16 0.3±11.15 vs 188.1±12.08)and(6.9±0.8 vs 14.1±1.2)mmHg, respectively ( P <0 05).Results of ultrasonic Doppler on lumbar muscle showed that the maximum and m ean blood flow velocities were increased by (0.17±0.02)kHz and (0.09±0.01)kHz, respectively, compared to those before operation. Conclusion Diagnosis of chronic lumbar pain induced by chronic compartment syndro me using methods of clinical physical examination and determination of lumbar mu scle intracompartment pressure is reliable. The opening decompression of the lum bar compartment in combination with trunk muscle exercise is effective for manag ement of this disease.