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[1]汪濤,肖志剛.定位腰椎斜扳手法結(jié)合超聲引導下腰脊神經(jīng)后內(nèi)側(cè)支阻滯術(shù)治療腰椎關(guān)節(jié)突關(guān)節(jié)綜合征的臨床研究[J].中醫(yī)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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定位腰椎斜扳手法結(jié)合超聲引導下腰脊神經(jīng)后內(nèi)側(cè)支阻滯術(shù)治療腰椎關(guān)節(jié)突關(guān)節(jié)綜合征的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第33卷
期數(shù):
2021年10期
頁碼:
9-15
欄目:
臨床研究
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:
汪濤; 肖志剛
(中國人民武裝警察部隊海警總隊醫(yī)院,浙江 嘉興 314033)
Author(s):
WANG Tao; XIAO Zhigang
China Coast Guard General Hospital of Chinese People’s Armed Police Force,Jiaxing 314033,Zhejiang,China
關(guān)鍵詞:
神經(jīng)傳導阻滯;  脊神經(jīng);  超聲檢查;  關(guān)節(jié)突關(guān)節(jié);  腰部斜扳法
Keywords:
nerve block;  spinal nerves;  ultrasonography;  zygapophysial joint;  lumbar oblique thrust
摘要:
目的:探討定位腰椎斜扳手法結(jié)合超聲引導下腰脊神經(jīng)后內(nèi)側(cè)支阻滯術(shù)治療腰椎關(guān)節(jié)突關(guān)節(jié)綜合征的臨床療效和安全性。方法:納入腰椎關(guān)節(jié)突關(guān)節(jié)綜合征患者74例,按照入組順序采用隨機數(shù)字表法隨機分為2組,每組37例,分別采用定位腰椎斜扳手法聯(lián)合超聲引導下腰脊神經(jīng)后內(nèi)側(cè)支阻滯術(shù)(手法聯(lián)合神經(jīng)阻滯組)和單純超聲引導下腰脊神經(jīng)后內(nèi)側(cè)支阻滯術(shù)(神經(jīng)阻滯組)治療。2組患者在以上治療的基礎(chǔ)上均口服美洛昔康分散片14 d,并進行臀橋、單側(cè)臀橋、側(cè)臥提臀、卷腹、小燕飛等腰肌康復鍛煉2個月。分別于治療前及神經(jīng)阻滯術(shù)后2周、6個月,采用數(shù)字評分法(numeric rating scale,NRS)對患者腰腿疼痛情況進行評分,采用Oswestry功能障礙指數(shù)(Oswestry disability index,ODI)量表對腰椎功能進行評分,進行腰部等速肌力測試并記錄屈伸肌峰值力矩比值,測量腰部無痛活動角度。記錄不良反應(yīng)發(fā)生情況。結(jié)果:①腰腿疼痛NRS評分。時間因素和分組因素存在交互效應(yīng)(F=20.423,P=0.000)。治療前后不同時間點之間腰腿疼痛NRS評分的差異有統(tǒng)計學意義,即存在時間效應(yīng)(F=19.278,P=0.000)。2組患者腰腿疼痛NRS評分總體比較,差異無統(tǒng)計學意義,即不存在分組效應(yīng)(F=10.423,P=0.479)。2組患者腰腿疼痛NRS評分均隨時間呈先下降后上升趨勢[(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組的變化趨勢不完全一致。治療前及神經(jīng)阻滯術(shù)后2周,2組患者腰腿疼痛NRS評分比較,差異均無統(tǒng)計學意義(t=0.086,P=0.931; t=0.646,P=0.519)。神經(jīng)阻滯術(shù)后6個月,手法聯(lián)合神經(jīng)阻滯組腰腿疼痛NRS評分低于神經(jīng)阻滯組(t=3.851,P=0.000)。②ODI評分。時間因素和分組因素存在交互效應(yīng)(F=33.423,P=0.000)。治療前后不同時間點之間患者ODI評分的差異有統(tǒng)計學意義,即存在時間效應(yīng)(F=24.364,P=0.000)。2組患者ODI評分總體比較,差異無統(tǒng)計學意義,即不存在分組效應(yīng)(F=7.192,P=0.593)。2組患者ODI評分均隨時間呈先下降后上升趨勢[(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組的變化趨勢不完全一致。治療前及神經(jīng)阻滯術(shù)后2周,2組患者ODI評分比較,差異均無統(tǒng)計學意義(t=0.715,P=0.476; t=0.868,P=0.388)。神經(jīng)阻滯術(shù)后6個月,手法聯(lián)合神經(jīng)阻滯組ODI評分低于神經(jīng)阻滯組(t=3.072,P=0.003)。③腰部屈伸肌峰值力矩比值。時間因素和分組因素存在交互效應(yīng)(F=14.005,P=0.001)。治療前后不同時間點之間患者腰部屈伸肌峰值力矩比值的差異有統(tǒng)計學意義,即存在時間效應(yīng)(F=12.621,P=0.000)。2組患者腰部屈伸肌峰值力矩比值總體比較,差異無統(tǒng)計學意義,即不存在分組效應(yīng)(F=9.043,P=0.341)。2組患者腰部屈伸肌峰值力矩比值均隨時間呈先下降后上升趨勢[(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組的變化趨勢不完全一致。治療前及神經(jīng)阻滯術(shù)后2周,2組患者腰部屈伸肌峰值力矩比值比較,差異均無統(tǒng)計學意義(t=0.357,P=0.721; t=0.091,P=0.928)。神經(jīng)阻滯術(shù)后6個月,手法聯(lián)合神經(jīng)阻滯組腰部屈伸肌峰值力矩比值低于神經(jīng)阻滯組(t=2.552,P=0.012)。④腰部無痛前屈角度。時間因素和分組因素存在交互效應(yīng)(F=29.473,P=0.000)。治療前后不同時間點之間患者腰部無痛前屈角度的差異有統(tǒng)計學意義,即存在時間效應(yīng)(F=21.413,P=0.000)。2組患者腰部無痛前屈角度總體比較,差異無統(tǒng)計學意義,即不存在分組效應(yīng)(F=12.347,P=0.573)。2組患者腰部無痛前屈角度均隨時間呈先下降后上升趨勢(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組的變化趨勢不完全一致。治療前及神經(jīng)阻滯術(shù)后2周,2組患者腰部無痛前屈角度比較,差異均無統(tǒng)計學意義(t=0.427,P=0.671; t=0.884,P=0.379)。神經(jīng)阻滯術(shù)后6個月,手法聯(lián)合神經(jīng)阻滯組腰部無痛前屈角度小于神經(jīng)阻滯組(t=5.343,P=0.000)。⑤腰部無痛后伸角度。時間因素和分組因素存在交互效應(yīng)(F=19.545,P=0.001)。治療前后不同時間點之間患者腰部無痛后伸角度的差異有統(tǒng)計學意義,即存在時間效應(yīng)(F=14.213,P=0.000)。2組患者腰部無痛后伸角度總體比較,差異無統(tǒng)計學意義,即不存在分組效應(yīng)(F=11.247,P=0.612)。2組患者腰部無痛后伸角度均隨時間呈先下降后上升趨勢(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組的變化趨勢不完全一致。治療前及神經(jīng)阻滯術(shù)后2周,2組患者腰部無痛后伸角度比較,差異無統(tǒng)計學意義(t=1.291,P=0.103; t=1.455,P=0.721)。神經(jīng)阻滯術(shù)后6個月,手法聯(lián)合神經(jīng)阻滯組腰部無痛后伸角度小于神經(jīng)阻滯組(t=6.433,P=0.000)。⑥安全性。手法聯(lián)合神經(jīng)阻滯組無不良反應(yīng)發(fā)生; 神經(jīng)阻滯組發(fā)生惡心、嘔吐等消化道癥狀1例,停藥后好轉(zhuǎn); 2組患者不良反應(yīng)發(fā)生率比較,差異無統(tǒng)計學意義(P=1.000)。結(jié)論:采用定位腰椎斜扳手法聯(lián)合超聲引導下腰脊神經(jīng)后內(nèi)側(cè)支阻滯術(shù)治療腰椎關(guān)節(jié)突關(guān)節(jié)綜合征,與單純采用超聲引導下腰脊神經(jīng)后內(nèi)側(cè)支阻滯術(shù)比較,二者在緩解患者腰腿疼痛、增加腰椎活動度、改善腰部肌力平衡、恢復腰椎功能方面近期療效相當、安全性相當,但前者的中期療效優(yōu)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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基金項目:嘉興市科技計劃項目(2018AD32181)
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