经皮激光椎间盘汽化减压术联合腰背肌功能锻炼治疗腰椎间盘突出症的疗效

Joint Therapeutic Effect of Percutaneous Laser Disc Decompression and Functional Exercise of Lumbar Dorsal Muscle on Lumbar Disc Herniation

目的观察经皮激光椎间盘汽化减压术(Percutaneous laser disc decompression,PLDD)联合腰背肌功能锻炼治疗腰椎间盘突出症(lumbar disc herniation,LDH)的疗效。方法符合标准LDH患者65例,按随机数字表法随机分为两组:治疗组患者33例,对照组患者32例。治疗组采用PLDD联合腰背肌功能锻炼;对照组采用单纯PLDD治疗。所有患者于术前、术后7 d、1和6个月采用视觉模拟疼痛评分法(Visual anal0gue scale,VAS)评价疼痛情况,术后6个月采用改良MacNab疗效标准评价临床疗效。结果 VAS疼痛评分:两组患者术前比较,差异无显著意义(P>0.05);术后7 d比较,两组患者缓解程度相似,差异无显著意义(P>0.05);治疗后1和6个月治疗组VAS疼痛低于对照组,差异有显著意义(P<0.05);组内比较,两组患者术后疼痛均明显缓解,术前与术后不同时间点比较,差异有显著意义(P<0.05)。两组患者术后随访6个月,采用改良的MacNab疗效评价标准进行疗效比较,治疗组优良率93.9%;对照组优良率71.9%,差异有显著意义(P<0.05)。结论近期疗效比较,两种治疗方案在缓解患者疼痛方面,均有良好的治疗效果,且两者缓解疼痛程度无差异;远期疗效比较,PLDD联合腰背肌功能锻炼组的疗效优于单纯PLDD治疗组。

Objective To observe the joint therapeutic effect of percutaneous laser disc decompression(PLDD) and back muscle function exercise on lumbar disc herniation(LDH).Methods Totally 65 qualified patients were divided randomly into two groups:the treatment group and control group.The patients in the treatment group were asked to do functional exercises of lumbar dorsal muscles while being given PLDD treatment,and the patients in the control group received solely PLDD treatment.For all the patients,the degrees of pain before the operation and 7 days,1 month and 6 months after the operation were evaluated respectively with visual analogue scale(VAS),and the clinical therapeutic effect 6months after the operation was assessed with modified MacNab curative effect standards.Results No obvious difference was found between the two groups in preoperative VAS pain score(P>0.05).As to the postoperative7 days VAS pain score,the difference between the two groups was not statistically significant(P > 0.05).However,the postoperative1 month and 6 months VAS pain scores of the treatment group were lower than those of the control group,and the differences were statistically significant(P < 0.05).Within each group,the pain of the patients relieved greatly after the operation,and the difference between the preoperative pain score and postoperative pain score at any time was statistically significant(P < 0.05).Modified MacNab curative effect evaluation standards were used to evaluate and compare the curative effect of the two groups during month-6 follow-up.The excellent rate of the treatment group was 93.94%,and that of the control group 71.88%,indicating a difference that P value was statistically significant(P < 0.05).Conclusions For short-term curative effect,both treatments perform well in pain relief,and the difference is not great.As to longterm curative effect,the combination of PLDD and functional exercise of lumbar dorsal muscle is better than pure PLDD treatment.