腰椎间盘突出症疼痛症状与治疗选择

在一组220例连续的腰椎间盘突出患者,评估了其腰腿痛的程度并探讨了影响临床治疗选择的因素。对每例患者采集临床特征因素。分别予以赋值后,用计算机行单因素直线相关,多元直线回归和多元逐步回归分析。结果表明:在所有三种分析中,休息时疼痛,疼痛加重因素,椎间隙压痛和直腿抬高试验是影响治疗选择的主要因素。患者有休息时疼痛,有疼痛加重因素,椎间隙有压痛并放射,直腿抬高试验小于30°时更倾向于手术治疗。     

Effect of acute nerve root compression on endoneurial fluid pressure and blood flow in rat dorsal root ganglia.

The objective of the current study was to test the hypothesis that crush injury to nerve root increases endoneurial fluid pressure (EFP) and decreases blood flow in the associated dorsal root ganglion (DRG). A total of 21 adult, female Sprague-Dawley rats had their left L5 nerve root and DRG exposed. The L5 nerve root was clamped for 2 s with a vascular suture clip just proximal to the DRG (compression group). Sham-operated animals without compression were used for control (control group). EFP was recorded with a servo-null micropipette system using a glass micropipette with tip diameter of 4 mum before and after 3 h of treatment. After the final measurement of EFP, DRG was excised and processed for histology. Blood flow in the DRG was continuously monitored by laser Doppler flow meter for 3 h. Three hours after treatment, EFP was 4.7+/-2.7 cm H(2)O in the compression group and 2.2+/-1.2 cm H(2)O in the control group (P<0.05). Edema was the principal pathologic findings seen consistently in the DRG from animals in the compression group. Blood flow in the compression group was reduced 10 min after compression. This reduction was statistically significant compared with that of the control (P<0.01). An acute compression to the nerve root increased endoneurial edema, increased EFP in the associated DRG, and reduced DRG blood flow. This combination of increased EFP and decreased blood flow in the DRG may result in neuronal ischemia and sensory dysfunction. These acute pathophysiologic changes may thus have a role in the pathogenesis of low back pain and sciatica due to disc herniation and spinal canal stenosis.     

坐骨神经痛患者的步态特征

目的分析总结坐骨神经痛患者的步态特征,辅助临床的诊断评估。方法连续住院治疗的43例伴有坐骨神经痛的腰椎间盘突出症患者,佩戴便携式步态分析仪后自由下平地行走120 m,同时纳入性别、年龄、身体质量指数(body mass index,BMI)匹配的43例健康受试者作为对照组。采集受试者的步态数据,包括7个时空参数(单支撑时间、双支撑时间、单双腿支撑时间比、步态周期时间、步速、步频、步长)以及4个加速度参数(拔腿强度、摆腿强度、地面冲击、足落地控制),对比患者与正常人、患者患侧与健侧下肢之间的步态差异。结果患者单支撑时间、单双腿支撑时间比、步速、步频、步长及4个加速度参数明显小于正常人,而双支撑时间延长。相比于患者健侧下肢,患侧下肢支撑时间、步频及4个加速度参数显著性减小,步长增加。结论坐骨神经痛患者患侧下肢运动功能出现障碍,影响步行能力。便携式步态分析仪可反映坐骨神经痛患者下肢的异常步态特征,为临床诊断评估提供参考。     

电针结合推拿治疗坐骨神经痛的临床疗效观察

目的:观察电针结合推拿治疗坐骨神经痛患者的临床疗效。方法:选择2014年2月至2014年12月期间在彭州市中医医院康复科治疗的90例坐骨神经痛患者作为研究对象,按照数字随机表法分为2组,每组45例。治疗组应用电针联合推拿治疗,对照组应用推拿治疗。比较2组患者治疗前后简化麦吉尔疼痛量表(SF-MPQ)、健康相关生活质量评分(SF-36)。结果:1)电针配合推拿组的PRI变化值(第4周评分与0周差值)大于推拿组。2)推拿组坐骨神经痛患者治疗前后SF-36量表中生理功能方面、躯体疼痛方面、总体健康方面、情感职能方面等4个方面维度分数有统计学意义(P0.05),电针加推拿组2组治疗前、治疗后生活质量量表各方面改善均有统计学意义(P0.05)。2组治疗前后生活质量各维度差异具有统计学意义(P0.05)。结论:电针结合推拿、推拿两种治疗方案均可缓解坐骨神经痛患者疼痛,两种治疗方案均可改善坐骨神经痛患者生活质量;但是2组相比较而言,电针结合推拿治疗在改善坐骨神经痛患者疼痛和提高生活质量方面优于推拿治疗。     

Stretching of roots contributes to the pathophysiology of radiculopathies

Purpose

To perform a synthesis of articles addressing the role of stretching on roots in the pathophysiology of radiculopathy.

Estimates of success in patients with sciatica due to lumbar disc herniation depend upon outcome measure

The objectives were to estimate the cut-off points for success on different sciatica outcome measures and to determine the success rate after an episode of sciatica by using these cut-offs. A 12-month multicenter observational study was conducted on 466 patients with sciatica and lumbar disc herniation. The cut-off values were estimated by ROC curve analyses using Completely recovered or Much better on a 7-point global change scale as external criterion for success. The cut-off values (references in brackets) at 12 months were leg pain VAS 17.5 (0–100), back pain VAS 22.5 (0–100), Sciatica Bothersomeness Index 6.5 (0–24), Maine-Seattle Back Questionnaire 4.5 (0–12), and the SF-36 subscales bodily pain 51.5, and physical functioning 81.7 (0–100, higher values indicate better health). In conclusion, the success rates at 12 months varied from 49 to 58% depending on the measure used. The proposed cut-offs may facilitate the comparison of success rates across studies.     

Etanercept attenuates pain-related behavior following compression of the dorsal root ganglion in the rat

Purpose  

TNFα is an inflammatory mediator related to neuropathic pain including sciatica. Much basic research suggests that anti-TNFα therapy may be useful for the treatment of sciatica. The purpose of this study was to clarify the effects of etanercept in a dorsal root ganglion (DRG) compression model.     

中药结合针刺治疗坐骨神经痛36例疗效观察

目的研究中药结合针刺方法治疗坐骨神经痛的临床疗效。方法 73例坐骨神经痛患者随机分为两组。对照组患者仅采用针刺方法治疗,研究组患者采用针刺结合中药调理方法,用药时间2个疗程。对两组患者的疗效进行比较分析。结果研究组患者显效率(30.55%)、总有效率(86.11%)明显高于对照组(14.71%、67.65%),均具有显著差异(P<0.05)。结论中药结合针刺方法治疗坐骨神经痛具有较好的效果,能够提高疗效,适合于临床推广。     

理筋减压推拿术对50例坐骨神经痛患者血清5-HT、前列腺素及钙离子的影响

目的:观察理筋减压推拿术对坐骨神经痛患者血清5-羟色胺(5-HT)、前列腺素(PG)及钙离子(Ca2+)的影响及疗效.方法:将150例本病患者随机分为A、B、C3组,每组50人.A组施以理筋减压推拿术,B组予独活寄生汤口服,C组予芬必得口服.3组均10 d为1个疗程,治疗两个疗程后观察患者血清5-HT、PG、Ca2+变化情况及临床疗效.结果:总有效率比较,差异有统计学意义(P<0.05或P<0.01),A组优于B、C两组,B组优于C组;5-HT、PG、Ca2+下降水平比较,差异有统计学意义(P<0.05或P<0.01),A组优于B、C两组,B组优于C组.结论:理筋减压推拿术能明显降低坐骨神经痛患者血清中5-HT、PG和Ca2+水平,改善或消除临床症状,是治疗坐骨神经痛的有效方法.     

CT引导治疗腰椎间盘突出引起的坐骨神经痛

目的总结CT引导治疗腰椎间盘突出引起的坐骨神经痛的方法及疗效。方法搜集以腰椎间盘突出为主要原因引起的坐骨神经痛87例。患者取俯卧位或侧卧位,在CT引导下用20G×100mm穿刺针,取侧旁穿刺进针,注射皮质类固醇等药物至硬膜外间隙。1个疗程为2周,治疗1～4次。术后无须住院。结果87例共治疗177次,穿刺成功率100%,无1例出血感染。效果好62例(71.3%),效果较好21例(24.1%),效果较差4例(4.6%)。结论CT引导治疗腰椎间盘突出引起的坐骨神经痛是一种易操作、微创伤、安全有效的非血管性介入治疗方法。