经皮激光汽化结合牵引治疗腰椎间盘突出症的临床研究
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摘要
目的:讨论经皮激光汽化术结合牵引治疗腰椎间盘突出症的疗效及相关的作用机制;总结腰椎间盘突出症在中西医中的不同认识和最新研究近况。
方法:将日照市中医医院住院采集的43例患者,随机分为治疗组23例、对照组20例。治疗组(A组)采用经皮激光汽化椎间盘减压术结合腰椎牵引治疗,对照组(B组)只采用经皮激光汽化术治疗,对患者的症状、体征及疼痛程度等情况进行观察记录,利用临床观察量表,作治疗前、后JOA评分、VAS评分测定及临床疗效评定,比较两组在腰腿痛的综合评分及疼痛量化指标上的变化。
结果:统计分析显示,A组JOA评分提高12.01士3.01,B组提高7.74士1.89,治疗后分数均较治疗前提高,A组优于B组;A组VAS评分下降4.94士0.79,B组评分下降3.45士0.79,优于B组;VAS分数治疗后有所下降,A组优于B组;临床疗效标准评定中,A组总有效率为95.7%;B组总有效率为80%;两组差异具有统计学意义(P<0.01),A组优于B组。
结论:经皮激光汽化结合牵引对治疗腰椎间盘突出症,较单纯应用经皮激光汽化治疗,在减轻患者疼痛、改善症状、提高生活质量方面效果更好。
Purpose: To review the recent studies and research progress in treating Lumbar Disc Herniations (LDH) with integrated traditional and western medicine;To investigate the curative effect and the possible therapeutic mechanism of percutaneous laser disc decompression (PLDD) in treatment of Lumbar Disc Herniations (LDH) with integrated percutaneous laser disc decompression (PLDD) and Lumbar vertebra traction;
Method: 43 patients of our hospital were divided into two groups in randomly: control group (20 cases) and treatment group (23 cases);Patients in the treatment group were under a treatment of integrated percutaneous laser disc decompression(PLDD) and Lumbar vertebra traction while control group patients were treated with percutaneous laser disc decompression (PLDD) only; An inventory of clinical curative effect was set up,pain states and symptoms assessed with the Japanese Orthopaedic Association low back pain disorders evaluation standard(JOA) and Visual Analogue Scale (VAS) were exactly recorded before and after the treatments of both groups .
Results: There are significant difference in JOA(the treatment group:12.01士3.01,the control group:7.74士1.89)(P<0.01)、VAS(the treatment group:4.94士0.79,the control group:3.45士0.79)(P<0.01)and effective rates(the treatment group:95.7%,the control group:80%)between the treatment group and the control group.
Conclusion: Treatment of Integrated percutaneous laser disc decompression (PLDD) and Lumbar vertebra traction is more effective in improving the symptoms、relieving pain and improving the living quality .
方法:将日照市中医医院住院采集的43例患者,随机分为治疗组23例、对照组20例。治疗组(A组)采用经皮激光汽化椎间盘减压术结合腰椎牵引治疗,对照组(B组)只采用经皮激光汽化术治疗,对患者的症状、体征及疼痛程度等情况进行观察记录,利用临床观察量表,作治疗前、后JOA评分、VAS评分测定及临床疗效评定,比较两组在腰腿痛的综合评分及疼痛量化指标上的变化。
结果:统计分析显示,A组JOA评分提高12.01士3.01,B组提高7.74士1.89,治疗后分数均较治疗前提高,A组优于B组;A组VAS评分下降4.94士0.79,B组评分下降3.45士0.79,优于B组;VAS分数治疗后有所下降,A组优于B组;临床疗效标准评定中,A组总有效率为95.7%;B组总有效率为80%;两组差异具有统计学意义(P<0.01),A组优于B组。
结论:经皮激光汽化结合牵引对治疗腰椎间盘突出症,较单纯应用经皮激光汽化治疗,在减轻患者疼痛、改善症状、提高生活质量方面效果更好。
Purpose: To review the recent studies and research progress in treating Lumbar Disc Herniations (LDH) with integrated traditional and western medicine;To investigate the curative effect and the possible therapeutic mechanism of percutaneous laser disc decompression (PLDD) in treatment of Lumbar Disc Herniations (LDH) with integrated percutaneous laser disc decompression (PLDD) and Lumbar vertebra traction;
Method: 43 patients of our hospital were divided into two groups in randomly: control group (20 cases) and treatment group (23 cases);Patients in the treatment group were under a treatment of integrated percutaneous laser disc decompression(PLDD) and Lumbar vertebra traction while control group patients were treated with percutaneous laser disc decompression (PLDD) only; An inventory of clinical curative effect was set up,pain states and symptoms assessed with the Japanese Orthopaedic Association low back pain disorders evaluation standard(JOA) and Visual Analogue Scale (VAS) were exactly recorded before and after the treatments of both groups .
Results: There are significant difference in JOA(the treatment group:12.01士3.01,the control group:7.74士1.89)(P<0.01)、VAS(the treatment group:4.94士0.79,the control group:3.45士0.79)(P<0.01)and effective rates(the treatment group:95.7%,the control group:80%)between the treatment group and the control group.
Conclusion: Treatment of Integrated percutaneous laser disc decompression (PLDD) and Lumbar vertebra traction is more effective in improving the symptoms、relieving pain and improving the living quality .
引文
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[7]顾利群.腰椎间盘突出症的辨证施治[J].中医骨伤科杂志,1999,7(3):28~29.
[8]黄伸.中药治疗腰椎间盘突出症的研究进展[J].时珍国医国药,2004,
[9]刘国东.腰椎间盘突出症[M]北京:科学技术文献出版社,2003,6(l):6,36一37,193,102,125一126,148一149,118
[10] Heliovaara M. Body heigh,obesity and risk of herniated lumbar intervertebral disC[J].Spine,1987,12:469.
[11]吴阶平,裘法祖主编.黄家驯外科学.第5版.北京:人民卫生出版社,1992:1258
[12] Brown,M.D.The pathophysiology of disc disease[J].Orthop Clin NArn 1971,2:359.
[13] Spencer DL.Anatomy and significance of fixation of the lumbosacral nerve roots inseiatica[J].Spine1983,8:672.
[14]杨旭,韩明舫,隋楠.腰椎间盘突出症缓解疼痛机理的研究[J].辽宁中医药学学报,2006,2:61~62.
[15] Piperno M,Hellio-le-Graverand MP,Reboul P etal.PhosPholipase A2 activity in herniated lumbar disca. Clinical correlations and inhibition by Piro-xicam[J].Spine, 1997,22(18):2061~2065.
[16] Gertzbein SD.Auto inununity in degenerative disc disease of the lutnbarspine[J].orthop ClimNAm,1995,(6):67
[17] Gertzbein SD. Auto immunity in degenerative disc disease of the lumbar Spine[J]. Orthop Clim N Am, 1975 ,6 :67.
[18]彭宝淦,王拥军(译自Spine Vol20(3):271.),施杞(校).突出椎间盘组织血管和细胞的碱性成纤维细胞生长因子的免疫反应性.中国中医骨伤科,1996,4(3):61.
[19]钟远鸣,朱少廷.腰椎间盘突出症中疼痛机理的研究现状[J].广西中医药,2003,4(26):10~12.
[20] Choy DS,AImm PA,Case RB,et a1.Laser radiation at various wavdensths for decompression 0f intervertebral disk experimental observation On autopsy specimens [J].Clin Orthop,1991,267:245.
[21] Choy DS,Case RB,Fidctms W,et a1.Percutaneous laser nucleolysis of lumbar disks[J].N Engl J Med,1987,317:771.
[22]王晨光,洪庆坚,朱海波,等.经皮穿刺半导体激光腰椎间盘汽化减压术的临床研究[J].中国激光医学杂志,2001,10(1):31
[23]马昕,顾湘杰.经皮腰椎间盘切除技术的发展[J].国外医学·创伤与外科基本问题分册,2000,21(3):135.
[24] Yonezawa T,Onomuka T,Kosaka R,et a1.The system and procedures of percutaneous intradiscal laser nucleotomy[J].spine 1990,15:1175.
[25]池永龙,黄其杉,王向阳,等.半导体激光颈椎间盘汽化减压术的实验研究[J].中国脊柱脊髓杂志,2002,12(6):427~429.
[26] Aschery PW.Laser trends in minimally invasive treatment:atherosclerosis,disk herniation[J].J Clin Laser Med Surg,1991,9(1):49.
[27]孙义忠,何强.经皮激光汽化减压治疗腰椎间盘突出症的最新研究进展[J].中国实用医药,2009,4(36):240~242.
[28] RangHP , BevanS , DragA. Chemical activation of nocieptive peripheral neurons[J].BrMel Bull,2006:135.
[29]潘化平,王健,张保国,等.改良经皮激光汽化椎间盘摘除术在腰椎间盘突出症治疗中的应用与研究[J].中国厂矿医学,2007,20(2):111~113.
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