经胸椎关节突银质针导热疗法治疗慢性胸背痛的疗效

发布时间：2018-08-01 14:55

【摘要】：研究背景:根据相关研究表明,CTDP的发生概率约为15%～22%[1],按照国际疼痛研究协会(IASP)改良的诊断标准,TVF病变引起的慢性胸背部疼痛约占34%～48%。在脊椎退变性疾病中,椎间盘退变是大家最容易意识到的退行性改变。临床工作中,对椎间盘退变和突出已经给予高度的重视,然而对小关节退变带来的问题认识不足或重视不够。长久以来,小关节由于其解剖特点及对影像检查技术和阅片要求较高等特点,其退变所引起的疾病常常被漏诊或误诊。实际上,椎间盘退变基本都伴随小关节退变,主要包括关节面的破坏,关节囊的钙化,关节突的增生以及相邻黄韧带的肥厚等等。另一方面,小关节参与构成双侧神经根管的后壁,其退变过程中的增生、钙化等继发病理改变,可导致占位性压迫神经通道,产生神经根性刺激症状、感觉障碍和根性瘫痪等,具有普遍性和危害性,所以我们应提高对小关节退变疾病的认识。目前大多数研究认为小关节退变的病理过程包括以下三个时期:早期退变主要表现为小关节软骨面代谢紊乱,炎症介质释放,软骨面变薄,缺损,关节松弛;中期退变则在早期基础之上,小关节突增生肥大、关节囊及其周围附着韧带逐步纤维化;退变晚期,程度进一步加重,主要表现为小关节增生、肥大,关节突关节由矢状面向冠状面移行而发生小关节内聚,关节软骨面完全被破坏,关节间隙变窄,功能受限,部分发生融合,关节囊纤维化、钙化,严重者骨化。退变发生在脊柱胸段,可能会引起一系列症状和体征,如胸背部疼痛、胸闷、束带感、呼吸困难、腹胀等。目前慢性胸背部疼痛的治疗方法主要为非手术治疗,采用药物、银质针导热治疗、神经阻滞、针灸理疗以及康复治疗等综合疗法。多数急性胸背痛患者经药物、康复理疗等治疗能缓解疼痛,少数急性胸背痛患者未能正规治疗而转为慢性胸背痛,药物治疗无效或病情严重者需要进一步行银质针导热治疗或神经阻滞等有创治疗。目的:探讨经胸椎关节突银质针导热疗法治疗胸椎小关节病变引起慢性胸背痛的疗效。方法:胸椎小关节病变引起慢性胸背痛患者110例,随机分为银质针组和药物组。前者采用经胸椎关节突银质针导热疗法,后者单纯应用药物治疗。治疗前和治疗后的2周、2个月和4个月随访,分别进行视觉模拟评分,并记录疼痛对患者工作和生活的影响程度。结果:银质针组的治疗后不同时点视觉模拟评分及对患者工作和生活的影响程度均优于对照组(P0.05)。结论:经胸椎关节突银质针导热疗法治疗胸椎小关节病变引起慢性胸背痛效果良好。
[Abstract]:Background: according to the relevant studies, the probability of occurrence of CTDPs is about 15% [1]. According to the modified diagnostic criteria of the International Association of pain Research (IASP), chronic chest and back pain caused by TTV lesions accounts for about 344,48%. Disc degeneration is one of the most recognizable degenerative changes in spinal degenerative diseases. In clinical work, high attention has been paid to disc degeneration and herniation, but insufficient understanding or attention has been paid to the problems caused by facet joint degeneration. For a long time, because of its anatomical characteristics and high requirements for image examination and film reading, the diseases caused by facet joint degeneration are often missed or misdiagnosed. In fact, intervertebral disc degeneration is associated with facet degeneration, including destruction of articular surface, calcification of articular capsule, hyperplasia of articular process and hypertrophy of adjacent ligamentum flavum, etc. On the other hand, facet joints are involved in the formation of the posterior wall of bilateral nerve root canals. The secondary pathological changes, such as hyperplasia and calcification during degeneration, may lead to the occupying compression of nerve channels, the production of symptoms of nerve root stimulation, sensory disorders and root paralysis, etc. It is universal and harmful, so we should improve the understanding of facet joint degeneration disease. At present, most studies believe that the pathological process of facet articular degeneration includes the following three stages: early degeneration is mainly characterized by metabolic disorder of facet articular cartilage surface, release of inflammatory mediators, thinning of cartilage surface, defect and relaxation of joint; On the other hand, the middle stage degeneration is based on the early stage, the facet process hyperplasia and hypertrophy, the articular capsule and its surrounding attachment ligament gradually fibrosis, the degenerative late stage, the degree further aggravation, the main manifestation is the facet joint hyperplasia, the hypertrophy, The facet articular cohesion occurs in the articular process from the sagittal to the coronal plane, the articular cartilage is completely destroyed, the articular space is narrowed, the function is limited, partial fusion occurs, the articular capsule is fibrosis, calcification, and serious ossification. Degeneration occurs in the thoracic segment of the spine and may cause a series of symptoms and signs, such as chest pain, chest tightness, band sense, dyspnea, abdominal distension, etc. At present, the main treatment methods of chronic chest and back pain are non-surgical treatment, drug, silver needle heat conduction treatment, nerve block, acupuncture and physical therapy and rehabilitation therapy. Most patients with acute chest and back pain can relieve the pain by medication, rehabilitation therapy, etc. A few patients with acute chest and back pain have become chronic chest and back pain without regular treatment. If the drug treatment is not effective or serious, it needs to be further treated with silver needle heat conduction or nerve block and other invasive treatment. Objective: to investigate the therapeutic effect of transthoracic vertebrae articular process silver needle heat conduction therapy for chronic thoracolumbar pain caused by thoracic facet joint disease. Methods: 110 patients with chronic chest and back pain caused by thoracic facet joint disease were randomly divided into silver needle group and drug group. The former was treated with silver needle through thoracic vertebrae and the latter was treated with drugs alone. The patients were followed up for 2 weeks, 2 months and 4 months before and after treatment. Visual analogue scores were performed, and the influence of pain on the work and life of the patients was recorded. Results: the visual analogue score at different time points and the influence on the work and life of patients in the silver needle group were better than those in the control group (P0.05). Conclusion: it is effective to treat chronic thoracolumbar pain caused by thoracic facet joint disease by transthoracic vertebrae silver needle heat conduction therapy.
【学位授予单位】：扬州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R681.5
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本文编号：2157941