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[1]董勝軍,郭中華.2種入路穿刺射頻熱凝聯(lián)合臭氧消融術(shù)治療L4～5腰椎間盤突出癥的臨床研究[J].中醫(yī)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種入路穿刺射頻熱凝聯(lián)合臭氧消融術(shù)治療L4～5腰椎間盤突出癥的臨床研究()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第29卷
期數(shù):
2017年08期
頁碼:
22-25,32
欄目:
臨床研究
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:
董勝軍1; 郭中華2
1.河南省鄭州市中醫(yī)院,河南 鄭州 450007; 2.河南省中醫(yī)院,河南 鄭州 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
關(guān)鍵詞:
椎間盤移位;  腰椎;  外科手術(shù); 微創(chuàng)性;  射頻熱凝術(shù);  臭氧;  臨床試驗(yàn)
Keywords:
Key words intervertebral disc displacement;  lumbar vertebrae;  surgical procedures; minimally invasive;  radiofrequency thermocoagulation;  Ozone;  clinical trial
摘要:
目的:比較經(jīng)關(guān)節(jié)突關(guān)節(jié)內(nèi)側(cè)緣椎板間隙入路和經(jīng)腰椎安全三角入路穿刺射頻熱凝聯(lián)合臭氧消融術(shù)治療L4～5腰椎間盤突出癥的臨床療效。方法:將符合要求的54例突出物在Ⅰ層2區(qū)a、b域內(nèi)的L4～5腰椎間盤突出癥患者隨機(jī)分為2組,采用經(jīng)關(guān)節(jié)突關(guān)節(jié)內(nèi)側(cè)緣椎板間隙入路穿刺射頻熱凝聯(lián)合臭氧消融術(shù)治療28例,采用經(jīng)腰椎安全三角入路穿刺射頻熱凝聯(lián)合臭氧消融術(shù)治療26例。分別于治療前和治療后1個(gè)月、3個(gè)月、6個(gè)月采用視覺模擬評分量表(visual analogue scale,VAS)評定患者的疼痛程度,于治療后6個(gè)月采用改良MacNab標(biāo)準(zhǔn)評定總體療效。結(jié)果:治療前后不同時(shí)點(diǎn)疼痛VAS評分的差異有統(tǒng)計(jì)學(xué)意義,即存在時(shí)間效應(yīng)(F=4.256,P=0.001)。2組患者的疼痛VAS評分均呈下降趨勢。2組患者疼痛VAS評分總體比較,差異有統(tǒng)計(jì)學(xué)意義,即存在分組效應(yīng)(F=7.267,P=0.032)。除治療前外[(6.50±0.71)分,(6.47±0.78)分,t=0.153,P=0.879],治療后各時(shí)點(diǎn)椎板間隙入路組的疼痛VAS評分均低于安全三角入路組[(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]。時(shí)間因素和分組因素存在交互效應(yīng)(F=4.358,P=0.001)。治療后6個(gè)月時(shí),按照改良MacNab標(biāo)準(zhǔn)評定,椎板間隙入路組優(yōu)13例、良10例、中4例、差1例,安全三角入路組優(yōu)9例、良9例、中5例、差3例。2組患者的總體療效比較,差異無統(tǒng)計(jì)學(xué)意義(Z=-1.178,P=0.239)。結(jié)論:對于突出物在Ⅰ層2區(qū)a、b域內(nèi)的L4～5椎間盤突出癥,采用經(jīng)關(guān)節(jié)突關(guān)節(jié)內(nèi)側(cè)緣椎板間隙入路穿刺射頻熱凝聯(lián)合臭氧消融術(shù)治療,減輕疼痛的作用優(yōu)于經(jīng)腰椎安全三角入路穿刺治療,但二者的總體療效相當(dāng)。
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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通訊作者:董勝軍 E-mail:[email protected]
更新日期/Last Update: 2017-12-29