经椎间孔选择性神经根阻滞术与虚痹方系疗虚痹型腰椎间盘突出症的临床研究
发布时间：2018-08-19 19:02
【摘要】：目的:经椎间孔选择性神经根阻滞术(Transforaminal selective nerve root block)是运用靶点穿刺技术直达病灶解决病痛;虚痹方是我院林一峰教授在"温养督脉理论"的基础上自拟的临床经验方。本文通过临床症状、实验室检查等指标观察,客观的评价两种治疗方案的临床疗效,为临床治疗腰椎间盘突出症提供最佳的治疗方案。方法:选取2015年2月～2016年2月在广州中医药大学第三附属医院脊柱骨科将符合研究条件的72例患者纳入研究,在签署《患者治疗方案知情同意书》的基础上将患者随机分为2组;试验A组:经椎间孔选择性神经根阻滞术+脊柱科常规路径治疗;试验B组:虚痹方(服用疗程4个疗程,1个疗程1周)+脊柱科常规路径治疗。随访12个月期间脱落4例,剔除3例(A组3例、B组4例),最终完成研究随访的65例患者(试验A组33例、试验B组32例)。治疗前、治疗后1天、1个月、6个月及12个月比较两组血清中白介素6(IL-6)浓度,治疗前、治疗后1天、1个月、3个月、6个月及12个月比较两组患者VAS评分、J0A评分及术后12个月Macnab优良率,客观评价两种治疗方案,从而找到更加快速、有效治疗方案。结果:两组患者一般资料(性别、年龄、年龄分布区间、病程及责任阶段等)比较差异,均无统计学意义(P0.05),基本一致。术后第1天疼痛VAS评分及下腰痛J0A评分、血清中IL-6浓度经椎间孔神经根阻滞术组改善显著,虚痹方组未见明显改善;术后1个月、术后3个月两组患者疼痛VAS评分、下腰痛J0A评分及术后1个月血清中IL-6浓度比较有显著性差异(P0.05),经椎间孔神经根阻滞术组治疗效果优于虚痹方组。术后6个月两组患者疼痛VAS评分、下腰痛J0A评分及血清中IL-6浓度比较无显著性差异(P0.05),两组治疗效果相同。术后12个月两组患者疼痛VAS评分、下腰痛J0A评分及血清中IL-6浓度比较有显著性差异(P0.05),经椎间孔神经根阻滞术组疗效降低,症状及体征反复,虚痹方组治疗效果优于经椎间孔神经根阻滞术组。治疗12个月后随访,虚痹方组总优良率为90.63%,经椎间孔神经根阻滞术组总优良率为66.67%。结论:本课题所选两种治疗方案均能有效改善虚痹型腰椎间盘突出症患者症状及体征。从血清中IL-6浓度、疼痛VAS评分及下腰痛J0A评分指标变化可知:两组前3个月短期疗效,经椎间孔选择性神经根阻滞术组优于虚痹方组;6个月疗效基本一致,12个月中长期疗效,虚痹方组优于经椎间孔选择性神经根阻滞术组。以中西医结合理论为基础,把两种治疗方案有效结合,相得益彰,值得应用。
[Abstract]:Objective: selective nerve root block through intervertebral foramen (Transforaminal selective nerve root block) is a clinical experience prescription based on the theory of warming and nourishing du pulse. By observing the clinical symptoms, laboratory examination and other indexes, this paper objectively evaluates the clinical efficacy of the two treatment schemes, and provides the best treatment scheme for the clinical treatment of lumbar disc herniation. Methods: from February 2015 to February 2016, 72 patients in the Department of Spine Orthopaedics, the third affiliated Hospital of Guangzhou University of traditional Chinese Medicine, were included in the study. Patients were randomly divided into two groups on the basis of signing "informed consent to patient treatment Scheme". Group A was treated with routine spinal pathway through intervertebral foramen selective nerve root block. Experimental group B: Xiubi prescription (4 courses of treatment, 1 week of treatment) spinal routine path therapy. During the 12 months follow-up, 4 cases were dropped off, 3 cases were removed (3 cases in group A, 4 cases in group B), 65 patients (33 cases in group A and 32 cases in group B) were finally followed up. Before treatment, 1 day, 1 month, 6 months and 12 months after treatment, the serum levels of interleukin 6 (IL-6) were compared between the two groups. After 1 day, 1 month, 3 months, 6 months and 12 months after treatment, the VAS score of J0A and the excellent and good rate of Macnab at 12 months after treatment were compared between the two groups, and the two treatment schemes were evaluated objectively, so as to find a more rapid and effective treatment scheme. Results: there was no significant difference between the two groups in general data (sex, age distribution interval, course of disease and responsibility stage) (P0.05). On the first day after operation, the VAS score of pain and the J0A score of low back pain were significantly improved in the serum IL-6 concentration in the intervertebral foramen nerve root block group, but not in the deficiency bi prescription group, and the pain VAS score in the two groups was significantly improved at 1 month and 3 months after operation. There was significant difference in J0A score of lower back pain and serum IL-6 concentration 1 month after operation (P0.05). The effect of nerve root block through intervertebral foramen was better than that of Xibi Fang group. There was no significant difference in pain VAS score, lower back pain J0A score and serum IL-6 concentration between the two groups 6 months after operation (P0.05). There were significant differences in pain VAS score, lower back pain J0A score and serum IL-6 concentration between the two groups 12 months after operation (P0.05). The effect of deficiency-bi prescription group was better than that of intervertebral foramen nerve root block group. After 12 months follow-up, the total excellent and good rate of Xiubi prescription group was 90.63 and that of intervertebral foramen nerve root block group was 66.67. Conclusion: the two treatments can effectively improve the symptoms and signs of the patients with asthenia-arthralgia type lumbar disc herniation. From the changes of serum IL-6 concentration, VAS score of pain and J0A score of low back pain, we can see that the short-term curative effect of the two groups in the first 3 months, the selective nerve root block through intervertebral foramen group is better than that in the deficiency Bi prescription group, the curative effect is basically the same at 6 months, and the medium and long term curative effect at 12 months. The deficiency bi prescription group was superior to the selective nerve root block group through intervertebral foramen. Based on the theory of integration of traditional Chinese and western medicine, the two therapeutic schemes are effectively combined to complement each other and are worthy of application.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9
本文编号：2192537
[Abstract]:Objective: selective nerve root block through intervertebral foramen (Transforaminal selective nerve root block) is a clinical experience prescription based on the theory of warming and nourishing du pulse. By observing the clinical symptoms, laboratory examination and other indexes, this paper objectively evaluates the clinical efficacy of the two treatment schemes, and provides the best treatment scheme for the clinical treatment of lumbar disc herniation. Methods: from February 2015 to February 2016, 72 patients in the Department of Spine Orthopaedics, the third affiliated Hospital of Guangzhou University of traditional Chinese Medicine, were included in the study. Patients were randomly divided into two groups on the basis of signing "informed consent to patient treatment Scheme". Group A was treated with routine spinal pathway through intervertebral foramen selective nerve root block. Experimental group B: Xiubi prescription (4 courses of treatment, 1 week of treatment) spinal routine path therapy. During the 12 months follow-up, 4 cases were dropped off, 3 cases were removed (3 cases in group A, 4 cases in group B), 65 patients (33 cases in group A and 32 cases in group B) were finally followed up. Before treatment, 1 day, 1 month, 6 months and 12 months after treatment, the serum levels of interleukin 6 (IL-6) were compared between the two groups. After 1 day, 1 month, 3 months, 6 months and 12 months after treatment, the VAS score of J0A and the excellent and good rate of Macnab at 12 months after treatment were compared between the two groups, and the two treatment schemes were evaluated objectively, so as to find a more rapid and effective treatment scheme. Results: there was no significant difference between the two groups in general data (sex, age distribution interval, course of disease and responsibility stage) (P0.05). On the first day after operation, the VAS score of pain and the J0A score of low back pain were significantly improved in the serum IL-6 concentration in the intervertebral foramen nerve root block group, but not in the deficiency bi prescription group, and the pain VAS score in the two groups was significantly improved at 1 month and 3 months after operation. There was significant difference in J0A score of lower back pain and serum IL-6 concentration 1 month after operation (P0.05). The effect of nerve root block through intervertebral foramen was better than that of Xibi Fang group. There was no significant difference in pain VAS score, lower back pain J0A score and serum IL-6 concentration between the two groups 6 months after operation (P0.05). There were significant differences in pain VAS score, lower back pain J0A score and serum IL-6 concentration between the two groups 12 months after operation (P0.05). The effect of deficiency-bi prescription group was better than that of intervertebral foramen nerve root block group. After 12 months follow-up, the total excellent and good rate of Xiubi prescription group was 90.63 and that of intervertebral foramen nerve root block group was 66.67. Conclusion: the two treatments can effectively improve the symptoms and signs of the patients with asthenia-arthralgia type lumbar disc herniation. From the changes of serum IL-6 concentration, VAS score of pain and J0A score of low back pain, we can see that the short-term curative effect of the two groups in the first 3 months, the selective nerve root block through intervertebral foramen group is better than that in the deficiency Bi prescription group, the curative effect is basically the same at 6 months, and the medium and long term curative effect at 12 months. The deficiency bi prescription group was superior to the selective nerve root block group through intervertebral foramen. Based on the theory of integration of traditional Chinese and western medicine, the two therapeutic schemes are effectively combined to complement each other and are worthy of application.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9
【参考文献】
相关期刊论文 前10条
1 姜昆;刘晴晴;陶宝琛;郑斌;魏成建;;补益肝肾、活血化瘀类中药复方治疗腰椎间盘突出症的Meta分析[J];中国药房;2016年36期
2 赵芝婷;周建;;针灸治疗腰椎间盘突出症的疗效观察[J];陕西中医;2016年10期
3 陈义方;容永纯;邓国梁;;绝对卧床休息对非手术治疗腰椎间盘突出症疗效的影响[J];中国实用医药;2016年24期
4 姜铮;;推拿治疗腰椎间盘突出症115例临床报告[J];世界最新医学信息文摘;2016年42期
5 宋明霞;沈友虎;胡长顺;;温针灸治疗腰椎间盘突出症临床疗效观察[J];中国中医急症;2016年02期
6 韩岳;夏群;徐宝山;吉宁;马信龙;;选择性神经根封闭术在微创治疗不典型椎间盘突出症中的定位应用价值[J];天津医科大学学报;2016年01期
7 宋志刚;牛小育;;腰椎间盘突出症患者血清指标与疼痛程度的关系研究[J];河北医学;2015年12期
8 张立;漆松涛;王海;周强;李宏;石瑾;彭林;陆云涛;;胸腰骶段脊神经根鞘结构的解剖学和组织学研究[J];中国临床解剖学杂志;2015年05期
9 张霄潇;李正勇;马玉玲;马双成;;中药枳实的研究进展[J];中国中药杂志;2015年02期
10 王俊井;雷刚刚;;椎间盘源性腰痛的病理生理改变与诊疗技术的进展[J];南昌大学学报(医学版);2013年10期
，本文编号：2192537
本文链接：https://www.wllwen.com/zhongyixuelunwen/2192537.html
最近更新
教材专著
