[1]汪涛,肖志刚.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研究[J].中医正骨,2021,33(10):9-15.
　WANG Tao,XIAO Zhigang.A clinical study of lumbar fixed-position oblique-pulling manipulation combined with ultrasound-guided lumbar spinal nerves posteromedial branch blocking for treatment of lumbar facet joint syndrome[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2021,33(10):9-15.
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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研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期数:
2021年10期
页码:
9-15
栏目:
临床研究
出版日期:
2021-10-20

文章信息/Info

Title:
A clinical study of lumbar fixed-position oblique-pulling manipulation combined with ultrasound-guided lumbar spinal nerves posteromedial branch blocking for treatment of lumbar facet joint syndrome
作者:
汪涛; 肖志刚
(中国人民武装警察部队海警总队医院,浙江 嘉兴 314033)
Author(s):
WANG Tao; XIAO Zhigang
China Coast Guard General Hospital of Chinese People’s Armed Police Force,Jiaxing 314033,Zhejiang,China
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
Keywords:
nerve block;  spinal nerves;  ultrasonography;  zygapophysial joint;  lumbar oblique thrust
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=0.000)。2组患者ODI评分总体比较,差异无统计学意义,即不存在分组效应(F=7.192,P=0.593)。2组患者ODI评分均随时间呈先下降后上升趋势[(16.84±4.29)分,(4.34±1.09)分,(4.79±1.21)分,F=17.479,P=0.000;(16.14±4.13)分,(4.56±1.09)分,(5.74±1.44)分,F=13.563,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ODI评分比较,差异均无统计学意义(t=0.715,P=0.476; t=0.868,P=0.388)。神经阻滞术后6个月,手法联合神经阻滞组ODI评分低于神经阻滞组(t=3.072,P=0.003)。③腰部屈伸肌峰值力矩比值。时间因素和分组因素存在交互效应(F=14.005,P=0.001)。治疗前后不同时间点之间患者腰部屈伸肌峰值力矩比值的差异有统计学意义,即存在时间效应(F=12.621,P=0.000)。2组患者腰部屈伸肌峰值力矩比值总体比较,差异无统计学意义,即不存在分组效应(F=9.043,P=0.341)。2组患者腰部屈伸肌峰值力矩比值均随时间呈先下降后上升趋势[(92.47±10.49)%,(72.34±8.05)%,(75.47±9.41)%,F=5.783,P=0.000;(91.47±13.41)%,(72.52±9.04)%,(81.59±11.14)%,F=4.025,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组患者腰部屈伸肌峰值力矩比值比较,差异均无统计学意义(t=0.357,P=0.721; t=0.091,P=0.928)。神经阻滞术后6个月,手法联合神经阻滞组腰部屈伸肌峰值力矩比值低于神经阻滞组(t=2.552,P=0.012)。④腰部无痛前屈角度。时间因素和分组因素存在交互效应(F=29.473,P=0.000)。治疗前后不同时间点之间患者腰部无痛前屈角度的差异有统计学意义,即存在时间效应(F=21.413,P=0.000)。2组患者腰部无痛前屈角度总体比较,差异无统计学意义,即不存在分组效应(F=12.347,P=0.573)。2组患者腰部无痛前屈角度均随时间呈先下降后上升趋势(76.54°±12.11°,38.72°±5.44°,40.44°±8.97°,F=9.249,P=0.000; 75.29°±13.05°,37.37°±7.52°,53.21°±11.44°,F=14.178,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组患者腰部无痛前屈角度比较,差异均无统计学意义(t=0.427,P=0.671; t=0.884,P=0.379)。神经阻滞术后6个月,手法联合神经阻滞组腰部无痛前屈角度小于神经阻滞组(t=5.343,P=0.000)。⑤腰部无痛后伸角度。时间因素和分组因素存在交互效应(F=19.545,P=0.001)。治疗前后不同时间点之间患者腰部无痛后伸角度的差异有统计学意义,即存在时间效应(F=14.213,P=0.000)。2组患者腰部无痛后伸角度总体比较,差异无统计学意义,即不存在分组效应(F=11.247,P=0.612)。2组患者腰部无痛后伸角度均随时间呈先下降后上升趋势(79.33°±7.09°,63.24°±6.51°,65.97°±8.04°,F=4.874,P=0.000; 80.41°±8.21°,64.97°±7.54°,74.97°±9.17°,F=6.037,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组患者腰部无痛后伸角度比较,差异无统计学意义(t=1.291,P=0.103; t=1.455,P=0.721)。神经阻滞术后6个月,手法联合神经阻滞组腰部无痛后伸角度小于神经阻滞组(t=6.433,P=0.000)。⑥安全性。手法联合神经阻滞组无不良反应发生; 神经阻滞组发生恶心、呕吐等消化道症状1例,停药后好转; 2组患者不良反应发生率比较,差异无统计学意义(P=1.000)。结论: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治疗腰椎关节突关节综合征,与单纯采用超声引导下腰脊神经后内侧支阻滞术比较,二者在缓解患者腰腿疼痛、增加腰椎活动度、改善腰部肌力平衡、恢复腰椎功能方面近期疗效相当、安全性相当,但前者的中期疗效优于后者。
Abstract:
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=14.234,P=0.000),while the 2 groups were inconsistent with each other in the variation tendency.There was no statistical difference in lumbago-leg pain NRS scores between the 2 groups before the treatment and at 2 weeks after the nerve blocking surgery(t=0.086,P=0.931; t=0.646,P=0.519).The lumbago-leg pain NRS scores were lower in combination therapy group compared to monotherapy group at 6 months after the nerve blocking surgery(t=3.851,P=0.000).②There was interaction between time factor and group factor in ODI scores(F=33.423,P=0.000).There was statistical difference in ODI scores between different timepoints before and after the treatment,in other words,there was time effect(F=24.364,P=0.000).There was no statistical difference in ODI scores between the 2 groups in general,in other words,there was no group effect(F=7.192,P=0.593).The ODI scores presented a time-dependent trend of decreasing firstly and increasing subsequently in the 2 groups(16.84±4.29,4.34±1.09,4.79±1.21 points,F=17.479,P=0.000; 16.14±4.13,4.56±1.09,5.74±1.44 points,F=13.563,P=0.000),while the 2 groups were inconsistent with each other in the variation tendency...

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备注/Memo

备注/Memo:
基金项目:嘉兴市科技计划项目(2018AD32181)
通讯作者:汪涛 E-mail:wangtao77890@163.com
更新日期/Last Update: 1900-01-01