作　　者： (董胜军）; (郭中华）;

机构地区： 河南省郑州市中医院,河南郑州450007

出　　处： 《中医正骨》 2017年第8期21-25,32,共6页

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L_(4~5)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L_(4~5)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Mac Nab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Mac Nab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L_(4~5)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。 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 Layer I . The patients were randomly divided into 2 groups and were treated with radiofrequency thermocoagulation com- bined with ozone ablation through inner margin of zygapophysial joint and interlaminar approach （28 patients）and lumbar safety triangle ap- proach（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 time- points before and after the treatment,in other words, there was time effect （ F = 4. 256, P = 0. 001 ）. The pain VAS scores presented a de- creasing 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 ap- proach 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 comprehe

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