摘要
目的:探讨定位腰椎斜扳手法结合超声引导下腰脊神经后内侧支阻滞术治疗腰椎关节突关节综合征的临床疗效和安全性。方法:纳入腰椎关节突关节综合征患者74例,按照入组顺序采用随机数字表法随机分为2组,每组37例,分别采用定位腰椎斜扳手法联合超声引导下腰脊神经后内侧支阻滞术(手法联合神经阻滞组)和单纯超声引导下腰脊神经后内侧支阻滞术(神经阻滞组)治疗。2组患者在以上治疗的基础上均口服美洛昔康分散片14 d,并进行臀桥、单侧臀桥、侧卧提臀、卷腹、小燕飞等腰肌康复锻炼2个月。分别于治疗前及神经阻滞术后2周、6个月,采用数字评分法(numeric rating scale,NRS)对患者腰腿疼痛情况进行评分,采用Oswestry功能障碍指数(Oswestry disability index,ODI)量表对腰椎功能进行评分,进行腰部等速肌力测试并记录屈伸肌峰值力矩比值,测量腰部无痛活动角度。记录不良反应发生情况。结果:①腰腿疼痛NRS评分。时间因素和分组因素存在交互效应(F=20.423,P=0.000)。治疗前后不同时间点之间腰腿疼痛NRS评分的差异有统计学意义,即存在时间效应(F=19.278,P=0.000)。2组患者腰腿疼痛NRS评分总体比较,差异无统计学意义,即不存在分组效应(F=10.423,P=0.479)。2组患者腰腿疼痛NRS评分均随时间呈先下降后上升趋势[(7.12±1.56)分,(1.47±0.29)分,(1.61±0.55)分,F=16.556,P=0.000;(7.09±1.43)分,(1.52±0.37)分,(2.13±0.61)分,F=14.234,P=0.000],但2组的变化趋势不完全一致。治疗前及神经阻滞术后2周,2组患者腰腿疼痛NRS评分比较,差异均无统计学意义(t=0.086,P=0.931;t=0.646,P=0.519)。神经阻滞术后6个月,手法联合神经阻滞组腰腿疼痛NRS评分低于神经阻滞组(t=3.851,P=0.000)。②ODI评分。时间因素和分组因素存在交互效应(F=33.423,P=0.000)。治疗前后不同时间点之间患者ODI评分的差异有统计学意义,即存在时间效应(F=24.364,P=0.
Objective:To explore the clinical curative effects and safety of lumbar fixed-position oblique-pulling manipulation combined with ultrasound-guided lumbar spinal nerves posteromedial branch blocking for treatment of lumbar facet joint syndrome(LFJS).Methods:Seventy-four LFJS patients were enrolled in the study and were randomly divided into 2 groups by using random digits table according to their enrolled sequence,37 cases in each group.The patients were treated with lumbar fixed-position oblique-pulling manipulation combined with ultrasound-guided lumbar spinal nerves posteromedial branch blocking(combination therapy group)and ultrasound-guided lumbar spinal nerves posteromedial branch blocking alone(monotherapy group)respectively,followed by oral application of meloxicam dispersible tablets for 14 days and psoas muscles rehabilitation exercises for 2 months in all patients.The lumbago-leg pain and lumbar function were scored by using numeric rating scale(NRS)and Oswestry disability index(ODI)respectively,moreover,the waist isokinetic muscle strength test was performed and the ratio of flexor muscle peak torque(PT)to extensor muscle PT was recorded,and the waist painless activity angle was measured before the treatment,at 2 weeks and 6 months after the nerve blocking surgery respectively,and the adverse reactions were observed and recorded.Results:①There was interaction between time factor and group factor in lumbago-leg pain NRS scores(F=20.423,P=0.000).There was statistical difference in lumbago-leg pain NRS scores between different timepoints before and after the treatment,in other words,there was time effect(F=19.278,P=0.000).There was no statistical difference in lumbago-leg pain NRS scores between the 2 groups in general,in other words,there was no group effect(F=10.423,P=0.479).The lumbago-leg pain NRS scores presented a time-dependent trend of decreasing firstly and increasing subsequently in the 2 groups(7.12±1.56,1.47±0.29,1.61±0.55 points,F=16.556,P=0.000;7.09±1.43,1.52±0.37,2.13±0.61 points,F
作者
汪涛
肖志刚
WANG Tao;XIAO Zhigang(China Coast Guard General Hospital of Chinese People’s Armed Police Force,Jiaxing 314033,Zhejiang,China)
出处
《中医正骨》
2021年第10期9-15,22,共8页
The Journal of Traditional Chinese Orthopedics and Traumatology
基金
嘉兴市科技计划项目(2018AD32181)。
关键词
神经传导阻滞
脊神经
超声检查
关节突关节
腰部斜扳法
nerve block
spinal nerves
ultrasonography
zygapophysial joint
lumbar oblique thrust
