[1]董胜军,郭中华.2种入路穿刺射频热凝联合臭氧消融术治疗L4～5腰椎间盘突出症的临床研究[J].中医正骨,2017,29(08):22-25,32.
　DONG Shengjun,GUO Zhonghua.Clinical study on radiofrequency thermocoagulation combined with ozone ablation through two kinds of approaches for treatment of L4/L5 disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(08):22-25,32.
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2种入路穿刺射频热凝联合臭氧消融术治疗L4～5腰椎间盘突出症的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期数:
2017年08期
页码:
22-25,32
栏目:
临床研究
出版日期:
2017-08-20

文章信息/Info

Title:
Clinical study on radiofrequency thermocoagulation combined with ozone ablation through two kinds of approaches for treatment of L4/L5 disc herniation
作者:
董胜军1; 郭中华2
1.河南省郑州市中医院,河南 郑州 450007; 2.河南省中医院,河南 郑州 450002
Author(s):
DONG Shengjun1; GUO Zhonghua2
1.Zhengzhou Hospital of Traditional Chinese Medicine,Zhengzhou 450007,Henan,China 2. Henan Provincial Hospital of Traditional Chinese Medicine,Zhengzhou 450002,Henan,China
关键词:
椎间盘移位;  腰椎;  外科手术; 微创性;  射频热凝术;  臭氧;  临床试验
Keywords:
Key words intervertebral disc displacement;  lumbar vertebrae;  surgical procedures; minimally invasive;  radiofrequency thermocoagulation;  Ozone;  clinical trial
摘要:
目的:比较经关节突关节内侧缘椎板间隙入路和经腰椎安全三角入路穿刺射频热凝联合臭氧消融术治疗L4～5腰椎间盘突出症的临床疗效。方法:将符合要求的54例突出物在Ⅰ层2区a、b域内的L4～5腰椎间盘突出症患者随机分为2组,采用经关节突关节内侧缘椎板间隙入路穿刺射频热凝联合臭氧消融术治疗28例,采用经腰椎安全三角入路穿刺射频热凝联合臭氧消融术治疗26例。分别于治疗前和治疗后1个月、3个月、6个月采用视觉模拟评分量表(visual analogue scale,VAS)评定患者的疼痛程度,于治疗后6个月采用改良MacNab标准评定总体疗效。结果:治疗前后不同时点疼痛VAS评分的差异有统计学意义,即存在时间效应(F=4.256,P=0.001)。2组患者的疼痛VAS评分均呈下降趋势。2组患者疼痛VAS评分总体比较,差异有统计学意义,即存在分组效应(F=7.267,P=0.032)。除治疗前外[(6.50±0.71)分,(6.47±0.78)分,t=0.153,P=0.879],治疗后各时点椎板间隙入路组的疼痛VAS评分均低于安全三角入路组[(2.28±0.36)分,(3.20±0.32)分,t=9.938,P=0.001;(1.47±0.55)分,(2.69±0.44)分,t=8.859,P=0.001;(0.90±0.39)分,(1.64±0.37)分,t=7.054,P=0.001]。时间因素和分组因素存在交互效应(F=4.358,P=0.001)。治疗后6个月时,按照改良MacNab标准评定,椎板间隙入路组优13例、良10例、中4例、差1例,安全三角入路组优9例、良9例、中5例、差3例。2组患者的总体疗效比较,差异无统计学意义(Z=-1.178,P=0.239)。结论:对于突出物在Ⅰ层2区a、b域内的L4～5椎间盘突出症,采用经关节突关节内侧缘椎板间隙入路穿刺射频热凝联合臭氧消融术治疗,减轻疼痛的作用优于经腰椎安全三角入路穿刺治疗,但二者的总体疗效相当。
Abstract:
ABSTRACT Objective:To compare the clinical curative effects of radiofrequency thermocoagulation combined with ozone ablation through inner margin of zygapophysial joint and interlaminar approach versus lumbar safety triangle approach for treatment of L4/L5 disc herniation.Methods:Fifty-four patients with L4/L5 disc herniation were enrolled in the study and their herniated disc located in Areas A and B of Zone 2 in LayerⅠ.The patients were randomly divided into 2 groups and were treated with radiofrequency thermocoagulation combined with ozone ablation through inner margin of zygapophysial joint and interlaminar approach(28 patients)and lumbar safety triangle approach(26 patients)respectively.The pain degrees were evaluated by using visual analogue scale(VAS)before treatment and at 1,3 and 6 months after the treatment respectively,and the total curative effects were evaluated and compared between the 2 groups by using improved MacNab standard at 6 months after the treatment.Results:There was statistical difference in the pain VAS scores between different timepoints before and after the treatment,in other words,there was time effect(F=4.256,P=0.001).The pain VAS scores presented a decreasing trend in the 2 groups.There was statistical difference in the pain VAS scores between the 2 groups in general,in other words,there was group effect(F=7.267,P=0.032).The pain VAS scores were lower in interlaminar approach group compared to safety triangle approach group at 1,3 and 6 months after the treatment respectively(2.28+/-0.36 vs 3.20+/-0.32 points,t=9.938,P=0.001; 1.47+/-0.55 vs 2.69+/-0.44 points,t=8.859,P=0.001; 0.90+/-0.39 vs 1.64+/-0.37 points,t=7.054,P=0.001)except before----------------------------------------------- treatment(6.50+/-0.71 vs 6.47+/-0.78 points,t=0.153,P=0.879).There was interaction between time factor and grouping factor(F=4.358,P=0.001).At 6 months after the treatment,the clinical comprehensive curative effects were evaluated according to the improved MacNab standard.Thirteen patients obtained an excellent result,10 good,4 fair and 1 poor in interlaminar approach group; while 9 patients obtained an excellent result,9 good,5 fair and 3 poor in safety triangle approach group.There was no statistical difference in total curative effect between the 2 groups(Z=-1.178,P=0.239).Conclusion:For patients with L4/L5 disc herniation which located in Areas A and B of Zone 2 in LayerⅠ,the therapy of radiofrequency thermocoagulation combined with ozone ablation through inner margin of zygapophysial joint and interlaminar approach surpasses the therapy through lumbar safety triangle approach in alleviating pain,while they are similar to each other in clinical curative effects.

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备注/Memo:
通讯作者:董胜军 E-mail:dsj511@126.com
更新日期/Last Update: 2017-12-29