臀上、臀中皮神经松解联合神经妥乐平封闭治疗腰椎间盘突出症术后残余神经痛的效果

发布时间：2018-05-05 09:15

本文选题：神经松解 + 神经妥乐平　；参考：《广东医学》2017年18期

【摘要】：目的探讨臀上、臀中皮神经松解联合神经妥乐平封闭治疗腰椎间盘突出症(LDH)术后残余神经痛的临床效果。方法选取LDH术后残余神经痛患者120例作为研究对象。按随机数字表法分为3组,对照组(n=40)、试验A组(n=40)和试验B组(n=40)。对照组术后给予生理盐水痛点封闭治疗,试验A组术后给予骶管封闭+利多卡因+神经妥乐平痛点封闭治疗,试验B组术后给予小切口行臀上及臀中皮神经松解封闭+利多卡因+神经妥乐平痛点封闭治疗。采用视觉模拟评分法(VAS)评估3组患者治疗前、治疗后2、8、16及24周腰腿痛程度,并比较治疗后3个月3组患者腰腿痛症状缓解优良情况,3组患者治疗后直腿抬高试验及加强试验阳性率,同时比较3组患者负重行走500 m及久坐1 h腰腿痛发生率。结果治疗前3组患者VAS评分相比差异无统计学意义(P0.05),且3组患者治疗后2、8、16及24周VAS评分均呈下降趋势,但试验A组和试验B组VAS评分均低于对照组,试验B组VAS评分低于试验A组,差异有统计学意义(P0.05);试验B组治疗后腰腿痛症状缓解优良率明显优于试验A组及对照组(P0.05);治疗前3组患者直腿抬高试验及加强试验阳性率相比差异无统计学意义(P0.05);试验B组治疗后直腿抬高试验及加强试验阳性率明显优于试验A组及对照组(P0.05);治疗后3个月试验B组患者负重行走500 m及久坐1 h腰腿痛发生率分别为12.50%、10.00%明显均低于试验A组的32.50%、30.00%以及对照组的42.00%、40.00%(P0.05)。结论臀上、臀中皮神经松解联合神经妥乐平封闭治疗LDH术后残余神经痛患者能有效改善患者残留的疼痛感,缓解腰腿痛症状,术后疗效显著,值得在临床上进一步推广。
[Abstract]:Objective to investigate the clinical effect of supragluteal and middle gluteal neurolysis combined with neurotropin blocking in the treatment of residual neuralgia after lumbar disc herniation (LDH). Methods 120 patients with residual neuralgia after LDH were selected. According to the method of random number table, the control group was divided into 3 groups: control group (n = 40), group A (n = 40) and group B (n = 40). The control group was treated with normal saline after operation, and group A was treated with sacral canal closure of lidocaine and neuropathic points after operation. In group B, small incision was given for the treatment of superior gluteal and middle gluteal nerve release and closure of Lidocaine. Visual analogue score (VASA) was used to evaluate the degree of low back and leg pain in 3 groups before and 2 weeks after treatment. The positive rates of straight leg elevation test and strengthening test were compared 3 months after treatment, and the incidence of lumbago and leg pain after walking 500 m and sitting for 1 hour were compared. Results there was no significant difference in VAS scores between the three groups before treatment (P 0.05), and the VAS scores of the 3 groups showed a downward trend at the 2nd week and 24th week after treatment, but the VAS scores in the trial group A and group B were lower than those in the control group. The VAS score of group B was lower than that of group A. The difference was statistically significant (P 0.05), the excellent and good rate of relieving low back and leg pain in group B was significantly better than that in group A and control group, and there was no significant difference in the positive rate of straight-leg elevation test and intensive test in three groups before treatment. The positive rate of straight leg raising test and strengthening test in group B was significantly higher than that in group A and control group, and the incidence of lumbago and leg pain in group B was 12.50% and 10.00% respectively 3 months after treatment. It was lower than that of group A (32.50%) and control group (42.00%) (P 0.05). Conclusion treatment of residual neuralgia in patients with residual neuralgia after LDH can improve the sense of residual pain and relieve the symptoms of lumbago and leg pain effectively. The curative effect of the treatment is remarkable and worthy to be popularized in clinical practice.
【作者单位】：承德医学院附属医院脊柱外一科;承德医学院附属医院眼科;承德医学院附属医院关节外科;围场满族蒙古族自治县中医院;围场满族蒙古族自治县医院骨科;
【基金】：承德市科学技术研究与发展计划项目(编号:20151043)
【分类号】：R687.3

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