射频消融术联合中药药熨治疗腰椎关节突关节源性腰痛的临床研究

发布时间：2018-06-21 23:29

本文选题：腰椎关节突关节源性腰痛 + 射频消融术　；参考：《广西中医药大学》2016年硕士论文

【摘要】：目的:通过对射频热凝靶点消融术联合中药药熨疗法治疗腰椎关节突关节源性腰痛的临床研究,观察其临床治疗效果,探寻一种创伤比较小,安全性相对比较高、疗效明确且长期疗效稳定的腰椎关节突关节源性腰痛的治疗方法。方法:从月2013年10月-2015年01月在广西中医药大学第一附属医院住院部,收集通过脊神经后内侧支封闭术确诊的腰椎关节突关节源性腰痛的患者98例,作为研究对象。所有患者按照住院号顺序随机分为三组。35例患者入选A组(手术联合保守治疗组),采用射频热凝消融术、臭氧注射、口服塞来昔布胶囊、红外线治疗、中药涂擦及中药药熨疗法等手术联合保守疗法进行治疗;33例患者入选B组(单纯手术组),进行射频热凝消融术、臭氧注射等单纯手术疗法;30例患者入选C组(单纯保守治疗组),进行口服塞来昔布胶囊、红外线治疗、中药涂擦及中药药熨疗法等单纯保守治疗方法进行治疗。三组所有患者均符合腰椎关节突关节源性腰痛的纳入标准,通过脊神经后内侧支封闭术确诊,排除腰椎间盘突出症、腰椎骨折、腰椎管狭窄症等特异性疾病,消化系统等严重的内疾病,孕妇及哺乳期妇女,精神障碍等患者。所有患者依从性好,无病例脱落现象。A组:男22例,女13例,平均年龄65.05±8.38岁;疼痛时间平均68.12±9.08月;受累的脊神经后内侧支L2-3节段的患者7例,L3-4节段的患者15例,L4-5节段的患者13例;VAS评分平均7.45±1.09分,腰椎JOA评分平均为15.02±1.42。B组:男19例,女14例,平均年龄68.12±9.08岁;疼痛时间平均117.33±7.77月;受累的脊神经后内侧支L2-3节段的患者6例,L3-4节段的患者17例,L4-5节段的患者10例;VAS评分平均6.36±1.08分,腰椎JOA评分15.48±0.90分。C组:男16例,女14例,平均年龄63.12±4.01岁;疼痛时间平均49.33±2.07月;受累的脊神经后内侧支L2-3节段的患者4例,L3-4节段的患者14例,L4-5节段的患者12例;VAS评分平均6.40±1.13分,腰椎JOA评分平均17.83±1.53分。三组患者的性别、年龄、脊神经后内侧支责任节段的人数等方面的一般资料,没有明显的差异性(P0.05),具有可比性。将三组患者分别进行射频热凝靶点消融术联合中药药熨疗法治疗与单纯手术、单纯保守治疗,观察其临床疗效。治疗方法:A组(手术联合保守治疗组):使用射频控温热凝器进行治疗。先进行电刺激测试:设置感觉神经刺激测试50Hz频率、电流为0m A-2.0m A,运动神经测试频率为2Hz,电流为0m A-2.0m A,当患者复制疼痛症状及腰部肌跳动时为测试成功。然后启动连续射频热凝模式,调整温度为65℃-70℃,周期为60秒。每个穿刺点3个周期。射频热凝消融术后,再使用医用臭氧发生器产生的O3-O2混合性气体,浓度为25mg/L,用注射器抽取5ml-10ml。注射入每个靶点进行臭氧消融术。根据具体病情的需要,酌情重复上述过程。术后予以口服塞来昔布胶囊、中药烫熨疗法、中药涂擦、特定电磁波谱(TDP)治疗仪等保守治疗。B组(单纯手术组):采用射频靶点热凝消融术、臭氧注射;C组(单纯保守治疗组):采用口服塞来昔布,1次/日,200mg/次。治疗2周后停药。记录患者消化系统等不良反应。并予以中药烫熨疗法、中药涂擦、特定电磁波谱治疗仪等理疗。观察指标:采用视觉模拟测试表(VAS)进行疗效评价。记录治疗前后不同时间段的VAS评分、腰椎JOA评分及其改善率。统计学分析:对所有数据使用SPSS17.0软件进行统计学分析。采用重复测量资料的方差分析对三组治疗前后不同时间的VAS评分、腰椎JOA评分进行组内比较有无差异性,对于三组在治疗后各个时间点的VAS评分、腰椎JOA评分的比较,应用方差分析-LSD检验比较治疗后各个时间上三组患者的VAS评分、腰椎JOA评分进行组间比较有无差异性。对三组间腰椎JOA评分改善率采用χ2检验比较其差异性。以P0.05为差异有统计学意义。结果:1.VAS评分比较A组:治疗后1天、3个月、6个月、1年不同时间点的VAS评分与治疗前相比均有所下降(P0.05),说明A组治疗有效;治疗后1天、3个月、6个月、1年不同时间点其VAS评分组内比较没有明显统计学差异(P0.05),说明A组治疗,起效快,效果显著,疗效持久稳定。B组:治疗后1天、3个月、6个月、1年不同时间点与治疗前相比均降低(P0.05),说明B组治疗有效;但是治疗后6个月、1年其VAS评分没有明显统计学差异(P0.05),说明B组治疗远期效果欠佳。C组:治疗后1天、3个月其VAS评分没有明显统计学差异(P0.05);治疗后6个月、1年VAS评分低于治疗前(P0.05),说明C组起效慢,疗效稳定。三组间比较:在治疗后1天、3个月、6个月、1年不同时间点的VAS评分,A组疗效优于B组、C组,B组疗效优于C组(P0.05)。2.腰椎JOA评分比较A组:治疗后1天、3个月、6个月、1年不同时间点的JOA评分与术前相比均有所升高(P0.05),说明A组治疗有效;治疗后1天、3个月、6个月、1年不同时间点其JOA评分组内比较没有明显统计学差异(P0.05),说明A组治疗,起效快,效果显著,疗效持久稳定。B组:治疗后1天、3个月、6个月、1年不同时间点与治疗前相比均升高(P0.05),说明B组治疗有效;但是治疗后6个月、1年其JOA评分没有明显统计学差异(P0.05),说明B组治疗远期效果欠佳。C组:治疗后1天、3个月其VAS评分没有明显统计学差异(P0.05);治疗后6个月、1年高于治疗前(P0.05),治疗后6个月、1年高于治疗前(P0.05),说明C组起效慢,疗效稳定。三组间比较:在治疗后1天、3个月、6个月、1年不同时间点的VAS评分,A组疗效优于B组、C组,B组疗效优于C组(P0.05)。结论:射频热凝靶点消融术联合中药药熨疗法、单纯手术治疗、单纯保守疗法均是治疗腰椎关节突关节源性腰痛的有效方法。射频热凝靶点消融术联合中药药熨治疗起效快,效果显著,疗效持久稳定,不易复发;单纯手术治疗起效快,效果明显,但是长期疗效不理想,容易复发;单纯保守治疗起效慢,治疗效果有效,疗效持久。所以射频消融术联合中药药熨治疗的疗效比单纯手术治疗、单纯保守治疗效果好,值得在临床推广。
[Abstract]:Objective: through the clinical study of radiofrequency thermocoagulation target ablation combined with traditional Chinese medicine ironing therapy for lumbar joint protruding lumbago, the clinical therapeutic effect was observed, and a method of treatment for lumbar joint source lumbago with relatively small trauma, relatively high safety and long-term curative effect was explored. In October 2013, -2015, -2015, at the First Affiliated Hospital of Guangxi University of traditional Chinese medicine, 98 patients with lumbar joint protrusion lumbar pain diagnosed by posterior medial branch of the spinal nerve were collected as the research object. All patients were randomly divided into three groups of.35 patients according to the order of hospitalization (surgery combined with conservative treatment group). Using radiofrequency thermocoagulation, ozone injection, oral Celecoxib Capsules, infrared therapy, traditional Chinese medicine and herbal medicine ironing, 33 patients were enrolled in group B (simple operation group), radiofrequency thermocoagulation, ozone injection and other simple surgical treatments, and 30 patients were enrolled in group C (simple conservative treatment). Group of three groups were treated with simple conservative treatment such as Celecoxib Capsules, infrared therapy, traditional Chinese medicine and herbal medicine ironing. All patients in the group were in accordance with the standard of lumbar joint protruding lumbago. The lumbar intervertebral disc herniation, lumbar fracture, and lumbar spinal canal stenosis were excluded through the posterior medial branch closure of the spinal nerve. Severe internal diseases such as narrow disease, digestive system and other serious internal diseases, pregnant women and lactation women, mental disorders and so on. All patients have good compliance and no case fall phenomenon.A group: 22 men, 13 women, average age 65.05 + 8.38 years; the average time of pain is 68.12 + 9.08 months; 7 patients with L2-3 segment of the medial posterior medial branch of the spinal nerve, L3-4 section. There were 15 patients in the segment and 13 patients in L4-5 segment; the average VAS score was 7.45 + 1.09 and the average of the lumbar JOA score was 15.02 + 1.42.B. The average age was 68.12 + 9.08, the average age was 68.12 + 9.08; the average pain time was 117.33 + 7.77 months; the victims of the L2-3 segment of the posterior medial branch of the spinal nerve, 17, L4-5, VAS, VAS, VAS, VAS, VAS, VAS, VAS, and VAS. The average score of the score was 6.36 + 1.08 points, and the JOA score of the lumbar spine was 15.48 + 0.90.C groups: 16 men and 14 women, with an average age of 63.12 + 4.01 years; the average pain time was 49.33 + 2.07 months; the patients with the L2-3 segment of the posterior medial branch of the spinal nerve were 4, the patients in the segment of the L4-5 segment, and the patients of the L4-5 segment were 12; the average VAS score was 15.48, and the JOA score of the lumbar spine was averaged. There was no significant difference (P0.05) in the gender, age, and the number of the number of the posterior medial branch of the spinal nerve (P0.05). The three groups of patients were treated with radiofrequency coagulation target ablation combined with traditional Chinese medicine ironing treatment and simple operation, and the treatment was treated with simple conservative treatment, and the clinical curative effect was observed. Treatment: A group (operation combined with conservative treatment group): use the radiofrequency temperature control thermocoagulator for treatment. Advanced electrical stimulation test: set the sensory nerve stimulation test 50Hz frequency, current 0m A-2.0m A, motor nerve test frequency 2Hz, current 0m A-2.0m A, when patients recover pain symptoms and waist muscle beating success. Then start the test. Then start up. The continuous radiofrequency thermocoagulation mode was adjusted at 65 C -70 C and 60 seconds. Each puncturing point was 3 cycles. After radiofrequency ablation, the O3-O2 mixed gas produced by the medical ozone generator was used for 25mg/L, and 5ml-10ml. was injected into each target with syringe and injected into each target. Repeat the process. After the operation, the oral Celecoxib Capsules, Chinese medicine ironing therapy, traditional Chinese medicine scrubbing, specific electromagnetic spectrum (TDP) therapy instrument and other conservative treatment group.B (simple operation group) were treated with radiofrequency target thermocoagulation, ozone injection, C group (simple conservative treatment group): oral celecoxib, 1 times / day, 200mg/ times. After 2 weeks, the drug was stopped. The patient's digestive system and other adverse reactions were recorded, and traditional Chinese medicine ironing therapy, Chinese medicine smear, specific electromagnetic spectrum therapy instrument and other physiotherapy were given. The observation index: the visual analogue test table (VAS) was used to evaluate the curative effect. The VAS score of different time periods before and after the treatment, the JOA score and the improvement rate of the lumbar spine were recorded. Statistical analysis: the use of SPS for all data S17.0 software for statistical analysis. The variance analysis of repeated measurement data was used to compare the VAS scores of the three groups at different times before and after treatment, and there was no difference in the group of lumbar JOA scores. For the three groups, the VAS score at each time point after treatment and the comparison of the lumbar JOA score should be compared with the variance analysis -LSD test to compare the time after treatment. There was no difference between the VAS scores of the upper three groups and the JOA score of the lumbar spine. The difference between the three groups was compared with the x 2 test. The difference between the P0.05 and the 1.VAS scores was statistically significant. Results: the 1.VAS score was compared with the A group: the VAS scores of the 3 months, 6 months and 1 years at different time points were compared with those before the treatment. The decrease (P0.05) showed that the treatment of group A was effective, 1 days, 3 months, 6 months, 1 years and different time points in the VAS score group had no significant statistical difference (P0.05), indicating that group A treatment was fast and effective, the curative effect was lasting and stable.B group: 1 days after treatment, 3 months, 6 months, and 1 years at different time points were lower than before treatment (P0.05), The treatment of group B was effective, but there was no significant difference in VAS score between 6 months and 1 years after treatment (P0.05), indicating that the long-term effect of B group was not good in.C group: 1 days after treatment and 3 months, there was no significant difference in VAS score (P0.05); 6 months after treatment, 1 year VAS score was lower than before treatment (P0.05), indicating that C group was slow and stable. Three groups were stable. Three groups were stable. Comparison: 1 days after treatment, 3 months, 6 months, 1 years of VAS score at different time points, group A was better than group B, group C, group C, group B and C group (P0.05).2. lumbar JOA score compared to group A group: 1 days after treatment, 3 months, 6 months, 1 years at different time points were higher than before operation (P0.05), indicating that the treatment was effective on 1 days, 3 months after treatment, 6, 3 months, 6. In 1 years, there was no significant difference in JOA score group (P0.05) at different time points (P0.05), indicating that group A was treated with rapid effect and significant effect. The curative effect was stable and stable.B group: 1 days, 3 months, 3 months, 1 years at different time points were all higher than before treatment (P0.05), indicating that group B was effective, but the JOA score of the group was 6 months after treatment, and 1 years did not score the JOA score. There were significant statistical differences (P0.05), indicating that the B group had poor long-term effect in group.C: 1 days after treatment and 3 months after the treatment, there was no significant difference in VAS score (P0.05); 6 months after treatment, 1 years higher than before treatment (P0.05), 6 months after treatment, 1 years higher than before treatment (P0.05), indicating that the C group had a slow onset and a stable effect. The three groups were compared at 1 days after treatment, 3. 6 months, 6 months, 1 years at different time points, A group effect is better than group B, group C, group B effect is better than group C (P0.05). Conclusion: radiofrequency thermocoagulation target ablation combined with traditional Chinese medicine ironing therapy, simple surgical treatment, simple conservative therapy are effective methods for the treatment of lumbar joint protruding low back pain. Radiofrequency ablation target ablation combined with traditional Chinese Medicine The curative effect is fast, the effect is remarkable, the curative effect is stable and stable, it is not easy to recur; the simple operation treatment is fast, the effect is obvious, but the long-term effect is not ideal, it is easy to recur; the simple conservative treatment is slow, the treatment effect is effective and the curative effect is lasting. So the curative effect of radiofrequency ablation combined with Chinese medicine ironing is better than the simple surgical treatment and the simple conservative treatment. The therapeutic effect is good and it is worth popularizing in the clinic.
【学位授予单位】：广西中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

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