[1]窦志刚,李志强.臭氧消融术治疗不同突出类型腰椎间盘突出症的疗效比较[J].中医正骨,2015,27(01):23-26.
　DOU Zhigang,LI Zhiqiang.Clinical study on ozone ablation for treatment of different types of lumbar disk herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):23-26.
点击复制

臭氧消融术治疗不同突出类型腰椎间盘突出症的疗效比较()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第27卷
期数:
2015年01期
页码:
23-26
栏目:
临床研究
出版日期:
2015-01-15

文章信息/Info

Title:
Clinical study on ozone ablation for treatment of different types of lumbar disk herniation
作者:
窦志刚1; 李志强2
1.河南省漯河市中医院,河南 漯河 462000;
2.河南省洛阳正骨医院/河南省骨科医院,河南 洛阳 471002
Author(s):
DOU Zhigang1; LI Zhiqiang2
1. Luohe Hospital of Traditional Chinese Medicine,Luohe 462000,Henan,China
2. Luoyang Orthopedic-Traumatological Hospital,Luoyang 471002,Henan,China
关键词:
椎间盘移位;  腰椎;  臭氧;  外科手术; 微创性;  回顾性研究
Keywords:
intervertebral disc displacement;  lumbar vertebrae;  ozone;  surgical procedures; minimally invasive;  retrospective studies
摘要:
目的:比较臭氧消融术对4种不同突出类型腰椎间盘突出症的临床疗效。方法:回顾性分析138例接受过臭氧消融术治疗的单节段腰椎间盘突出症患者的病例资料,按CT图像上病变椎间盘的突出情况分型,中央型53例、旁中央型36例、侧隐窝型31例、外侧型18例。比较治疗前、治疗结束后和末次随访时采用视觉模拟评分法(visual analogue score,VAS)评定的腰腿痛情况,以及治疗结束后和末次随访时采用Macnab腰腿痛手术疗效评价标准评定的疗效评定结果。结果:治疗后2周3例患者症状未见缓解,接受手术治疗,其中旁中央型1例、侧隐窝型2例,其余135例患者均获得随访,随访时间3～6个月,中位数5个月。治疗前4组患者腰腿痛VAS评分比较,差异无统计学意义[(5.06±1.22)分,(4.97±1.18)分,(5.00±1.13)分,(5.06±1.00)分,F=0.046,P=0.987]。治疗结束后及末次随访时4组患者腰腿痛VAS评分比较,组间差异均有统计学意义[(1.38±0.97)分,(1.53±1.08)分,(2.48±1.26)分,(1.56±0.92)分,F=7.657,P=0.000;(1.21±0.91)分,(1.47±1.00)分,(2.35±1.31)分,(1.44±0.86)分,F=8.439,P=0.000]; 中央型、旁中央型及外侧型患者的VAS评分均高于侧隐窝型(P=0.000,P=0.000; P=0.001,P=0.003; P=0.009,P=0.011),其余各组间两两比较,组间差异均无统计学意义。治疗结束后及末次随访时,中央型、旁中央型及外侧型患者的临床疗效均优于侧隐窝型(R^-中央型=59.40,R^-旁中央型=67.22,R^-外侧型=66.44,R^-侧隐窝型=91.19,χ2=14.017,P=0.003; R^-中央型=61.93,R^-旁中央型=64.73, R^-外侧型=64.39,R^-侧隐窝型=85.28,χ2=9.603,P=0.035)。结论:臭氧消融术可迅速缓解腰椎间盘突出症患者的腰腿痛症状,临床疗效显著; 与中央型、旁中央型及外侧型相比,该方法对侧隐窝型的疗效较差,临床治疗时可联合应用其他介入疗法。
Abstract:
Objective:To compare the clinical effects of ozone ablation in the treatment of four types of lumbar disk herniation(LDH).Methods:The medical records of 138 patients with single segment LDH who were treated with ozone ablation were analyzed retrospectively.The LDH belonged to central type(53),lateral central type(36),lateral recess type(31)and lateral type(18).Lumbocrural pain were observed and compared between the 2 groups before the treatment and after the treatment and at last follow-up respectively by using the visual analogue scale(VAS).The curative effects were evaluatd according to Macnab lumbocrural pain efficacy criteria and were compared between the 2 groups after the end of the treatment and at last follow-up.Results:Three patients,belonged to central type(1)and lateral recess type(2),received operation at 2 weeks after the treatment because of poor curative effect; while all of the others were followed up for 3-6 months with a median of 5 months.There was no statistical difference in VAS scores between the 4 groups before the treatment(5.06+/-1.22,4.97+/-1.18,5.00+/-1.13,5.06+/-1.00 points,F=0.046,P=0.987).There was statistical difference in VAS scores between the 4 groups after the end of the treatment and at last follow-up(1.38+/-0.97,1.53+/-1.08,2.48+/-1.26,1.56+/-0.92 points,F=7.657,P=0.000; 1.21+/-0.91,1.47+/-1.00,2.35+/-1.31,1.44+/-0.86 points,F=8.439,P=0.000).The VAS scores of central type,lateral central type and lateral type were higher than that of the lateral recess type(P=0.000,P=0.000; P=0.001,P=0.003; P=0.009,P=0.011).There was no statistical difference between the rest paired groups.The central type,lateral central type and lateral type surpassed the lateral recess type in the total curative effect after the end of the treatment and at last follow-up(R^-central type=59.40,R^-lateral central type=67.22,R^-lateral type=66.44,R^-lateral recess type=91.19,χ2=14.017,P=0.003; R^-central type=61.93,R^-lateral central type=64.73,R^-lateral type=64.39,R^-lateral recess type=85.28,χ2=9.603,P=0.035).Conclusion:Ozone ablation can rapidly relieve lumbocrural pain of the patients with LDH and it has significant curative effect on LDH except for lateral recess type,which would be treated in combination with other interventional therapies.

参考文献/References:

[1] 李振.阿斯哈尔,谷淑梅.多种介入方法联合应用治疗腰椎间盘突出症256例疗效观察[J].介入放射学杂志,2011,20(1):45-47.
[2] 中华医学会放射学分会介入学组.腰椎间盘突出症的介入和微创治疗操作规范的专家共识[J].中华放射学杂志,2014,48(1):10-12.
[3] 韩松辉,张敏,孔凡国,等.医用臭氧治疗腰椎间盘突出症疗效观察[J].中医正骨,2009,21(5):25-27.
[4] 肖文庆,杜海峡,程立军,等.经皮激光椎间盘汽化减压加臭氧消融术治疗腰椎间盘突出症[J].中医正骨,2011,23(8):60-62.
[5] 胡有谷.腰椎间盘突出症[M].北京:人民卫生出版社,2011:173-175.
[6] 杨洸.腰腿痛防止手册[M].北京:九州出版社,2011:44-46.
[7] 国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:201.
[8] 陈立,张明月,兰秀芳,等.仰卧拔伸手法结合颈肌等长收缩锻炼治疗颈型颈椎病的临床研究[J].中医正骨,2013,25(10):17-20, 23.
[9] Macnab I.Negative disc exploration.An analysis of the causes of nerve-root involvement in sixty-eight patients[J].J Bone Joint Surg Am,1971,53(5):891-903.
[10] 陈智能,谢丽丽,叶俊材,等.椎间盘造影经皮激光椎间盘汽化减压术联合臭氧消融术治疗椎间盘源性腰痛[J].中医正骨,2014,26(3):49-50, 53.
[11] 彭静,邢辉,张铂,等.臭氧治疗腰椎间盘突出症104例疗效分析[J].介入放射学杂志,2010,19(2):114-116.
[12] 魏汉贤,许俊榆,吴海斌,等.臭氧关节腔内注射联合充髓通络汤离子导入治疗膝骨关节炎[J].中医正骨,2014(4):70-71.
[13] 王俊杰,杨春燕,王随修.臭氧溶解术治疗腰椎间盘突出症[J].中医正骨,2008,20(10):56.
[14] 黄章洪,王俊军,江光明,等.盘内注射小剂量臭氧治疗腰椎间盘突出症80例临床观察[J].颈腰痛杂志,2013,34(5):420-421.
[15] 彭涛,姚新苗,吕一,等.臭氧消融联合射频热凝治疗腰椎间盘突出症临床研究[J].中医正骨,2013,25(11):13-15.
[16] 高宗根,殷世武,项廷淼,等.臭氧联合胶原酶注射与单纯臭氧治疗腰椎间盘突出症的疗效观察[J].介入放射学杂志,2011,20(1):42-44.

相似文献/References:

[1]邓红军.硫酸钙骨水泥椎体成形联合后路短节段椎弓根螺钉 内固定治疗创伤性胸腰椎骨折[J].中医正骨,2015,27(10):35.
[2]张莉,秦丹霞,张细姣.腹针治疗椎间盘源性腰痛[J].中医正骨,2015,27(10):38.
[3]吴青坡,孙国绍,王林杰.后路椎管减压联合腰椎椎弓根钉动态稳定装置内固定 治疗单节段腰椎退行性疾病[J].中医正骨,2015,27(10):42.
[4]郭小伟,梅伟,潘玉林,等.一期后路病灶清除纳米仿生骨椎体支撑体植骨融合 内固定治疗胸腰椎结核[J].中医正骨,2015,27(07):66.
[5]孙广江,崔海舰.络病理论指导下应用独活寄生汤加减治疗腰椎间盘突出症[J].中医正骨,2015,27(12):37.
　SUN Guangjiang,CUI Haijian.Clinical study on oral application of Duhuo Jisheng Tang Jiajian(独活寄生汤加减)under the guidance of collaterals disease theory for treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):37.
[6]阮朝阳,曾强华,朱群威.口服消栓口服液和甲钴胺胶囊治疗腰椎间盘突出症 经皮椎间孔镜术后下肢残留神经症状[J].中医正骨,2015,27(12):71.
[7]陈冠军,陈扬,庄汝杰.可灌注骨水泥椎弓根螺钉系统 在老年腰椎疾患手术中的应用[J].中医正骨,2015,27(02):40.
[8]万宏波,马海燕,蒋云霞,等.口服益气化瘀汤联合功能锻炼治疗腰椎退行性疾病 术后残留腰腿痛的临床研究[J].中医正骨,2015,27(06):1.
　WAN Hongbo,MA Haiyan,JIANG Yunxia,et al.Clinical study on oral application of Yiqi Huayu Tang(益气化瘀汤)combined with functional exercise for the treatment of postoperative residual lumbocrural pain in patients with lumbar degenerative disease[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):1.
[9]贺振年,康信勇,徐洪伟,等.骨盆矢状位参数对退行性腰椎滑脱症的影响[J].中医正骨,2015,27(06):19.
　HE Zhennian,KANG Xinyong,XU Hongwei,et al.Effect of pelvic parameters in the sagittal plane on degenerative lumbar spondylolisthesis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):19.
[10]李鹏,徐世涛,谭磊.椎旁肌间隙入路伤椎单侧植骨内固定治疗 单节段胸腰椎骨折[J].中医正骨,2015,27(06):43.
[11]徐帮杰,杨楠,白伟杰,等.坐位定点旋转整复法治疗腰椎间盘突出症的疗效观察[J].中医正骨,2015,27(11):17.
　XU Bangjie,YANG Nan,BAI Weijie,et al.Observation on the curative effect of fixed-point rotational reduction in sitting position in the treatment of lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):17.
[12]白春晓,贾育松,孙旗,等.中医药在腰椎间盘突出症围手术期应用的研究进展[J].中医正骨,2015,27(11):65.
[13]王少纯,周英杰.郭维淮教授运用活血益气通经汤治疗腰椎间盘突出症的经验[J].中医正骨,2015,27(11):75.
[14]苏洪,张雪林.患侧下肢牵引配合腰椎斜扳法治疗 极外侧型腰椎间盘突出症[J].中医正骨,2015,27(10):40.
[15]谢冬群,黄中梁,叶金丽.加强隔附子饼灸治疗肾阳虚型腰椎间盘突出症的 临床研究[J].中医正骨,2015,27(09):18.
　XIE Dongqun,HUANG Zhongliang,YE Jinli.Clinical study on intensive aconite root cake separated moxibustion in the treatment of kidney-yang-deficiency-type lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):18.
[16]沈海良,钱万锋,周骁栋.针刀松解联合局部封闭与口服中药治疗腰椎间盘突出症[J].中医正骨,2015,27(09):46.
[17]王仁灿,黄炎洪,潘伟江,等.45°肩踝悬吊牵引下撞击腰椎疗法治疗L5S1椎间盘突出症[J].中医正骨,2015,27(08):51.
[18]任博文,杨豪.口服桂葛萆薢汤加减配合功能锻炼治疗 寒湿型腰椎间盘突出症[J].中医正骨,2015,27(08):53.
[19]丁晓医,周子静.射频热凝联合臭氧注射治疗腰椎间盘突出症的护理[J].中医正骨,2015,27(12):81.
[20]仇湘中,蒋盛昶,张信成,等.红外热成像图在腰椎间盘突出症证候疗效评定中的应用[J].中医正骨,2015,27(02):17.
　QIU Xiangzhong,JIANG Shengchang,ZHANG Xincheng,et al.Application of infrared thermal imaging to curative effect evaluation of SYMPTOM COMPLEX for patients with lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(01):17.

备注/Memo

备注/Memo:
2014-10-11收稿 2014-11-18修回
更新日期/Last Update: 2015-01-30