药刀治疗第三腰椎横突综合征的临床研究

目的：探讨药刀在L3横突综合征治疗中的应用及临床效果。方法：自2009年12月至2010年10月,应用药刀治疗L3横突综合征38例,33例获得随访,其中男19例,女14例;年龄28～58岁,平均（37.6±7.8）岁;病程10d～14个月,平均（126.9±14.7）d。患者以单侧腰部酸痛,侧方弯腰受限,久坐或劳累后腰背部酸痛加重,并向患侧大腿及腘窝部放射,但酸痛不过膝关节为主要临床症状。患侧L3横突尖部压痛明显,局部可触及挛缩肌束,X线片示L3横突左右不对称,结合CT、MR检查以排除椎管狭窄、肿瘤及椎间盘突出病变。应用药刀挑拨、松解粘连,随后注入复合药物：0.2%利多卡因3ml、曲安奈德5ml（50mg）加0.9%生理盐水至10ml。经1次治疗疼痛无明显改善者1周后行第2次治疗,治疗次数不超过3次。治疗前及治疗后（随访时）按照JOA下腰痛评分系统从下腰痛、腿痛或麻木感、步态、直腿抬高试验、感觉障碍、运动障碍和膀胱功能等方面进行疗效评定。结果：33例获随访,时间2～12个月,平均4个月。伤口均Ⅰ甲愈合,无其他并发症。临床症状均有明显改善,其中经1次治疗者22例,2次7例,3次4例。JOA评分由术前的（7.03±3.81）分恢复至术后的（13.29±3.78）分。优26例,良5例,可2例。结论：L3横突综合征是药刀治疗的适应证之一,只要诊断明确,病灶定位准确,操作方法正确,其临床疗效确切,并发症少,安全性高。

Treatment of the 3rd lumbar vertebrae transverse process syndrome with spatula

Objective: To investigate the application and clinical effects of spatula for the treatment of the 3rd lumbar vertebrae transverse process syndrome.Methods: From December 2009 to October 2010,38 patients with the 3rd lumbar vertebrae transverse process syndrome were treated by spatula,of them,33 patients were follow-up.Among the patients,19 cases were male and 14 cases were female,with an average age of (37.6±7.8) years (ranged from 28 to 58 years).The course of this diseases ranged from 10 days to 14 months with an average of(126.9±14.7)days.The main symptoms of the patients including unilateral lumbar pain,lateral bend waist limitation,the ache became even worse after exertion or prolonged sitting and radiated to the affected side of thigh and popliteal fossa,but the pain never exceed knee joint.The tenderness at the tip of the 3rd lumbar vertebrae was obviously and the contract muscle bundle could be touched.The X-rays showed the two sides of the transverse were asymmetric.CT or MRI was used to exclude spinal stenosis,tumor,and intervertebral disk hernia.Spatula was applied for sow discord and solution accretion,and injected compound medicine(0.2% Lidocaine 3 ml,Triamcinolone acetonide 5 ml,add 0.9% physiological sailine 2 ml to 10 ml).If the symptoms did not improved after the first treatment,start the second treatment one week later,but it was not more than three times.According to the standard of JOA score,the effects before and after treatment were evaluated by low back pain,leg pain or numbness,gait,Straight Leg Raising test,sensory and movement disorder,bladder function test.Results: Thirty-three patients were followed up for 2-12 months with an average of 4 months.All of the incisions were healed without complications.The clinical symptoms were improved and 22 cases were treated once,7 cases twice and 4 cases 3 times.According to JOA evaluation criteria,the score before and after treatment was increased from(7.03±3.81)to(13.29±3.78),and 26 cases got excellent result,5 good,2 fair.Conclusion: 3rd lumbar vertebrae transverse process syndrome is one of the indications of the spatula.If the diagnose is correct,lesions position precisely located and operation performed properly,the treatment by spatula showed confirmed therapeutic effects,low complication and high safety.