自体富血小板血浆关节内精准注射治疗腰椎小关节综合征的疗效观察

发布时间：2018-04-15 16:12

本文选题：腰椎小关节综合征 + 富血小板血浆　；参考：《吉林大学》2017年硕士论文

【摘要】：目的:观察评价自体富血小板血浆腰椎小关节内注射治疗腰椎小关节综合征的临床疗效,旨在为腰椎小关节综合征关节内介入治疗寻找一种更加安全、有效的新型疗法。材料与方法:选取2015年6月至2016年8月吉林大学第二医院脊柱外科门诊,经初步问诊、查体、检查诊断为疑似腰椎小关节综合征的患者119名,进一步经严格筛查后剩余48人进入本研究随机分组,其中实验组24人,对照组24人。给予实验组患者腰椎小关节腔内自体PRP介入注射治疗,给予对照组患者传统的局麻药与激素的混合药物的小关节腔内介入注射治疗。随访6个月,对比两组间治疗前后的不同状态下视觉模拟评分(VAS)和疼痛缓解率[(治疗前VAS评分-治疗后VAS评分)/治疗前VAS评分],腰椎功能评价[包括Roland-Morris功能障碍调查表(RMQ)和Oswestry功能障碍指数(ODI)],改良Mac Nab评分以及相关并发症发生情况。结果:1.一般资料:两组患者在性别,年龄,体重指数,病程,疾病特征等基本资料中,无明显统计学差异(P0.05)。2.疼痛变化比较(VAS评分):与治疗前相比,无论实验组还是对照组,无论休息状态下还是弯腰状态下,腰部疼痛在治疗1周开始均有明显减轻(P0.05)。在治疗后短期1周、1月时,对照组疼痛减轻比实验组明显(P0.05)。3.腰椎功能变化比较(RMQ评分和ODI评分):与治疗前情况对比,两组患者腰椎功能均有明显好转(P0.05)。但短期效果对照组更佳,中长期效果实验组更优。4.治疗后主观满意度比较(改良Mac Nab评分):对照组短期满意度更好,在治疗后1个月优良率最高,为83.33%;而实验组中长期满意度更好,在治疗后6个月优良率最高,为75.00%。5.安全性比较:两组患者治疗后均没有出现感染、排斥反应、神经损伤等药物和穿刺并发症。两组患者疼痛加重情况均在治疗后即刻发生率高,其余时间发生率较低。结论:1.影像协助下的腰椎小关节内精准注射是腰椎小关节综合征的一种安全、有效的治疗方法。2.从短期疗效看,传统局麻药和激素的混合药物的治疗效果更佳,但自体PRP也有效果。3.从中长期疗效看,自体PRP比传统局麻药和激素的混合药物更加有效,是一种更优的治疗选择。
[Abstract]:Objective: to evaluate the clinical effect of autologous platelet-rich plasma intra articular injection in the treatment of lumbar facet joint syndrome in order to find a more safe and effective new therapy for interarticular treatment of lumbar facet joint syndrome.Materials and methods: 119 patients with suspected lumbar facet joint syndrome were selected from June 2015 to August 2016 in the Department of Spinal surgery, Jilin University second Hospital.After strict screening, the remaining 48 persons were randomly divided into experimental group (n = 24) and control group (n = 24).The patients in the experimental group were treated with intra articular autologous injection of PRP and the patients in the control group were treated with intra articular intra articular injection of traditional local anesthetic and hormone.Follow up for 6 months,The visual analogue score (VAS) and pain relief rate (VAS score before and after treatment / VAS score before and after treatment), lumbar function evaluation [including Roland-Morris dysfunction questionnaire] and Oswestry were compared between the two groups before and after treatment.Dysfunction index (ODI), improved Mac Nab score and related complications.The result is 1: 1.General data: there was no significant difference between the two groups in sex, age, body mass index, course of disease, disease characteristics and other basic data.Comparison of pain changes and VAS score: compared with before treatment, no matter the experimental group or the control group, no matter the rest state or the stooping state, the pain in the waist was significantly alleviated at the beginning of 1 week treatment (P 0.05).In a short period of 1 week and 1 month after treatment, the pain relief in the control group was significantly higher than that in the experimental group.Comparison of lumbar functional changes with RMQ score and ODI score: compared with pre-treatment, the lumbar function of the two groups improved significantly (P 0.05).But the short-term effect control group is better, the medium-long-term effect experimental group is better. 4.Comparison of subjective satisfaction after treatment (modified Mac Nab score: the short-term satisfaction rate of the control group was better, the highest excellent and good rate was 83.33 at one month after treatment, while the long-term satisfaction rate in the experimental group was better, the excellent and good rate was the highest at 6 months after treatment, 75.00.5.Safety comparison: there were no drug or puncture complications such as infection, rejection, nerve injury and so on.The incidence of pain aggravation was higher in both groups immediately after treatment, and the incidence of other time was lower.Conclusion 1.Image assisted intra articular injection is a safe and effective treatment for lumbar facet joint syndrome.In the short term, the combination of traditional local anesthetic and hormone is more effective, but autogenous PRP also has the effect of. 3. 3.In the medium and long term, autologous PRP is more effective than traditional local anesthetic and hormone mixture, and it is a better treatment choice.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.3

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