脊神经后支定位温银针治疗非特异性下腰痛的临床研究

目的 观察以脊神经后支定位温银针治疗非特异性下腰痛的临床效果.方法 将非特异性腰痛患者120例,按随机数字表法分为两组,对照组60例给予夹脊穴温针治疗,1次/d,5次为1疗程,疗程间休息1d,共2个疗程;治疗组60例给予脊神经后支主干支定位温银针治疗,隔日治疗1次,5次为1个疗程,最多2个疗程,疗程间休息2d.结果 两组患者疼痛程度较治疗前减轻,腰椎功能均有不同程度的恢复,以治疗组的改善情况更为明显,两组疗效比较,差异有统计学意义.结论 脊神经后支定位温银针治疗非特异性下腰痛,疗效确切,操作简单,并发症少.     

腰脊神经后支射频治疗非特异性下腰痛

目的观察腰脊神经后支射频热凝术治疗非特异性下腰痛的效果及安全性。方法选择30例本组患者，在C臂机下穿刺定位行腰3～腰5双侧脊神经后支射频热凝术，工作模式：温度70～76℃，时间60～120s，术后3天及1个月观察腰痛症状缓解情况及双侧竖棘肌痉挛缓解情况。结果优良28例，良好2例。结论在影像定位下行腰脊神经后支射频治疗非特异性下腰痛效果满意且安全。     

CT引导下腰脊神经后支射频热凝对慢性腰痛的疗效观察

目的观察射频热凝腰脊神经后支治疗非特异性腰痛的疗效.方法将120例确诊为慢性非特异性腰痛患者随机分为对照组与观察组各60例.对照组行物理治疗和药物治疗,观察组在药物治疗的基础上行射频热凝腰脊神经后支治疗,评估2组疗效、治疗前后疼痛视觉模拟评分(VAS)结果观察组较对照组疗效及疼痛缓解明显,差异有统计学意义(P<0.05)结论腰脊神经后支射频热凝治疗慢性非特异性腰痛能缓解疼痛,不良反应少.     

非特异性腰痛的治疗

根据腰脊神经后支分布的解剖特点,应用曲氨耐德复合利多卡因行腰脊神经后支阻滞治疗非特异性腰痛,取得了满意的效果,报道如下。     

针灸治疗非特异性腰痛临床观察

目的观察密集型银质针导热术、脊神经后支针灸治疗非特异性腰痛的临床疗效。探讨更安全、有效、简单、易行的治疗措施。方法将非特异性腰痛患者102例,随机分为两组,对照组给予密集型银质针导热术治疗,治疗组给予脊神经后支针灸治疗。结果治疗组较对照组,近期及远期效果无差异。结论脊神经后支针灸治疗非特异性腰痛,疗效确切、操作简单、痛苦程度减少、经济负担减轻、并发症降低。     

非特异性腰痛的对因治疗

非特异性腰痛是长期困扰临床医师的难题,目前存在着诊断混乱、疗效差的状况。为了明确病因以及做到对因治疗,我院进行了长期的基础和临床研究,并做了大量的文献调研,在此基础上总结出了几类非特异性腰痛的病因诊断及对因治疗措施。(1)脊神经后支综合征:因脊神经后支主干受机械刺激所致,治疗方法有液氮冷冻脊神经后支等。(2)腰椎间盘源性腰痛:由于腰椎间盘变性所致,可行腰椎间盘切除。(3)小关节综合征:小关节本身病变引发腰痛的情况很少,多数是由于小关节脱位刺激了旁边的脊神经后支所致。治疗方法同脊神经后支综合征。(4)腰椎不稳:由椎间连接松弛所致,可行腰椎融合。(5)棘上棘间韧带损伤:因棘间韧带损伤所致,疗法有封闭加小针刀松解术等。(6)内脏源性腰痛:是盆腔疾患的牵涉性痛,治疗原发病是关键。此几类非特异性腰痛的病因诊断及对因治疗措施供同行参考、商榷。     

非特异性腰痛的对因治疗

非特异性腰痛是长期困扰临床医师的难题，目前存在着诊断混乱、疗效差的状况。为了明确病因以及做到对因治疗，我院进行了长期的基础和临床研究，并做了大量的文献调研，在此基础上总结出了几类非特异性腰痛的病因诊断及对因治疗措施。（1）脊神经后支综合征：因脊神经后支主干受机械刺激所致，治疗方法有液氮冷冻脊神经后支等。（2）腰椎间盘源性腰痛：由于腰椎间盘变性所致，可行腰椎间盘切除。（3）小关节综合征：小关节本身病变引发腰痛的情况很少，多数是由于小关节脱位刺激了旁边的脊神经支所致。治疗方法同脊神经后支综合征。（4）腰椎不稳：由椎间连接松驰所致，可行腰椎融合。（5）棘上棘间韧带损伤：因棘间韧带损伤所致，疗法有封闭加小针刀松解术等。（6）内脏源性腰痛：是盆腔疾患的牵涉性痛，治疗原发病是关键。此几类非特异性腰痛的病因诊断及对因治疗措施供同行参考、商榷。     

臭氧加针刀松解脊神经后支治疗不典型腰痛232例

目的:观察臭氧加针刀松解脊神经后支治疗不典型腰痛的疗效.方法:在主诉痛区同侧上溯3个节段的某椎体找到原发痛点,在原发痛点、对应脊神经后支行臭氧注射和针刀松解术.结果:共治疗232例,优良率94.82%,3个月后随访196例,优良率91.83%.结论:臭氧加针刀松解脊神经后支治疗不典型腰痛,疗效确切,并发症少,疗程短,痛苦小,具有临床实用价值.     

椎旁体感诱发电位在神经根病变中的定位探讨

目的了解椎旁体感诱发电位（SSEP）在腰椎后路手术前后皮层电位潜伏期和波幅的改变，探讨椎旁SSEP在神经根病变中的定位价值。方法5例L4、5椎管狭窄症患者做术前、术后L4节段双侧椎旁SSEP，记录其P30潜伏期和波幅。10例L4、5单侧椎间盘突出伴有同侧临床腰腿痛症状的腰椎间盘突出症患者，做术前L4节段双侧椎旁SSEP及双侧胫神经SSEP，记录椎旁SSEP的P30潜伏期和胫神经SSEP的P40潜伏期。结果椎管狭窄症患者的椎旁SSEP手术前后P30潜伏期差异明显，术后较术前缩短，而P30波幅无明显差异。L4、5单侧椎间盘突出症患者双侧椎旁SSEP的P30潜伏期差异明显，双侧胫神经SSEP的P40潜伏期无明显差异。结论神经根病变可能引起椎旁SSEP的P30潜伏期延长，椎旁SSEP在神经根病变的定位上有参考价值。     

胫后神经体感诱发电位对脊髓病变的定位诊断

目的：研究胫后神经体感诱发电位（ＳＥＰ）对脊髓病变的定位诊断价值。方法：电刺激胫后神经，于腰椎、胸椎、颈椎和头皮置记录电极，依次记录ＣＥ，Ｎ２４，Ｎ２８和Ｐ４０电位峰潜伏期。共检测１５例对照组和２９例经磁共振（ＭＲＩ）证实的腰骶神经根或脊髓病变患者。结果：（１）ＣＥ，Ｎ２４，Ｎ２８和Ｐ４０电位均异常，见于腰骶神经根病变。（２）ＣＥ正常，Ｎ２４，Ｎ２８和Ｐ４０异常，或Ｎ２４异常，余电位均正常，见于腰骶髓病变。（３）ＣＥ，Ｎ２４正常，Ｎ２８和Ｐ４０异常，见于胸髓病变。（４）ＣＥ，Ｎ２４，Ｎ２８正常，Ｐ４０异常，见于第６颈椎以上病变。结论：胫后神经ＳＥＰ临床上具有定位诊断价值     

负压按摩治疗仪治疗武警战士非特异性下腰痛疗效观察

目的：观察负压按摩治疗仪和经皮神经电刺激（TENS）对非特异性下腰痛的疗效。方法：58例非特异性下腰痛武警战士按就诊顺序随机分为负压按摩组（25例）与TENS组（23例）,治疗后2、4周采用疼痛数字评定量表（PNRS）、Oswestry功能障碍指数（ODI）、罗兰·莫里斯残疾问卷（RMDQ）指一地距离评价临床效果。结果：治疗2周后,负压按摩组PNRS优于TENS组（P〈0．05）,而两组的指一地距离、ODI、RMDQ差异无统计学意义（P〉0．05）。治疗4周后,负压按摩组的PNRS、ODI、RMDQ、指一地距离均优于TENS组,差异有统计学意义（P〈0．05）。结论：负压按摩治疗仪是治疗非特异性下腰痛的有效方法,操作简单,适于在基层部队推广。     

Reduction in anxiety during treatment with exercise and duloxetine is related to improvement of low back pain-related disability in patients with non-specific chronic low back pain

Background: Non-invasive treatment is generally recommended for patients with non-specific chronic low back pain (CLBP). However, the impact of combination therapy with physical exercise and a serotonin-norepinephrine reuptake inhibitor has not been clarified in patients with non-specific CLBP. This study assessed the efficacy of combination treatment with exercise and duloxetine on non-specific CLBP and aimed to identify factors that contributed to improvement of LBP-induced disability.Methods: This prospective study was conducted on consecutive outpatients with non-specific CLBP. Patients received a supervised home-based exercise program and duloxetine administration for 15 weeks. The Roland-Morris Disability Questionnaire (RDQ), Numerical Rating Scale (NRS), Hospital Anxiety and Depression Scale (HADS), and Pain Catastrophizing Scale (PCS) were assessed at baseline and 15 weeks. Multiple logistic regression modeling was used to identify factors associated with an improvement in RDQ. Results: Forty-two patients were enrolled. Overall, scores on the RDQ, NRS, and PCS (total score, magnification, helplessness) were significantly reduced at 15 weeks (p < 0.01 for all). An improvement of disability was confirmed in 22 patients (52%). A higher HADS depression score before and after the intervention was significantly associated with a lack of improvement in disability (p < 0.01). Further, a reduction in HADS anxiety score over 15 weeks was a significant factor associated with an improvement in disability (odds ratio: 1.99;95% CI: 1.26-3.65). Conclusions: Supervised exercise plus duloxetine resulted in favorable outcomes and an improvement of LBP-related disability in approximately 50% of patients. A reduction in anxiety over treatment was associated with the improved disability.     

后路椎体间融合治疗椎间盘源性下腰痛30例分析

目的探讨后路椎体间融合术治疗椎间盘源性下腰痛的方法及效果。方法2005年6月~2007年1月对30例椎间盘源性下腰痛患者行后路椎体间融合及经椎弓根螺钉内固定术。结果27例术后腰腿痛症状基本消失,3例仍有轻度腰痛,均恢复正常生活和工作。术前、术后VAS腰痛评分及ODI评分进行配对比较的t检验差异有统计学意义。结论椎体间融合是治疗椎间盘源性下腰痛的有效手术方法。     

CT导引下深部冷冻加中药熏蒸治疗非特异性腰痛的临床研究

目的 探讨CT导引下深部冷冻加中药熏蒸治疗非特异性腰痛的方法.方法 在CT导引下经皮穿刺到脊神经后支,对神经分支施行深部冷冻,再加上中药局部熏蒸,从而达到根治非特异性腰痛的目的.结果 临床观察54例,疗效显著,经半年以上随访,优良率为94.5%.结论 本法操作简单、安全、高效,是一种治疗非特异性腰痛的新方法.     

Determination of Median Nerve Somatosensory Evoked Potentials in 27 Patients with Hemiplegia

Summary: Twenty-seven in-patients with hemiplegia following brain injury were studied by using up per extremity median nerve somatosensory evoked patentials (SVEP), Brunnstrom assessment in hemiplegic hand and assessment of the patients‘ activities of daily lioing (ADL) (Barthel index). The upper extremity median nerve SEP on the affected and normal sides was determined. By using Kovin dba standard, upper extremity median nerve SEP was graded in accordance with N20. The correla tion between the differences of SEP N20 amplitude and the latencies on the both sides and the Barthel index scores was analyzed. A Spearman correlation analysis was made between the median nerve SEP N20 grades and Brunnstrom stages in hand or ADL on the affected side. The results showed that up per extremity median nerve SEP grades were positively correlated with those of the Brunnstrom stages in hand (r1 =0. 6925, P1＜0. 01). The correlation coefficient between SEP N20 grades and patients‘ ADL grades was r2= 0. 5015, P2＜0.01. It was concluded that upper extremity median nerve SEP could be used as a sensitive electrophysiological predictor to clinically assess hemiplegic hand function. SEP N20 might play a role in predicting the ADL of the patients with hemiplegia to some extent, but could not be used as a sensitive predictor to directly observe and predict the ADL of the patients.     

整脊手法配合脊柱诊断治疗仪治疗骨盆偏斜继发腰痛

目的观察整脊手法（Chiropractic）对骨盆倾斜性腰痛及纠正骨盆偏斜的治疗效果。方法在详细了解病史、阅读X光片及临床检查基础上,对患者先行侧卧位的整脊手法治疗,动作以高速度／低振幅为原则;每次手法治疗后即刻对腰骶部及骶髂关节周围给予脊柱诊断仪治疗。结果在本研究所治疗的13个病例中,治疗前两侧髂嵴高度差为（1．73±0．61）cm,治疗后两侧髂嵴高度为（0．28±0．10）cm,治疗前后二者差异有显著性;治疗后患者疼痛症状显著缓解或消除。结论双侧髂嵴不等高是骨盆旋转与位移的一种特殊方式,用两侧髂嵴高度差表示病变程度和疗效评价标准方便实用。整脊手法配合仪器治疗此类腰痛效果显著。     

射频消融髓核成形术治疗椎间盘源性腰痛的初步观察

目的探讨等离子射频消融髓核成形术治疗椎间盘源性腰痛的临床效果。方法对38例诊断为椎间盘源性腰痛的患者采用了等离子消融髓核成形术,术前均先行椎间盘造影,探讨手术方法、比较手术前后疼痛症状并进行疗效评定。结果所有病例随访5～12个月,平均为7个月,术前VAS评分平均为7.3分,术后下降为2.1分(P<0.05),术后4个月随访时为2.5分(P<0.05),主观改善满意率为92.1%,无手术相关并发症发生。结论等离子射频消融髓核成形术治疗椎间盘源性腰痛近期效果满意,但手术适应证仍需严格控制。     

45例三叉神经痛患者体感诱发电位的分析与探讨

目的：探讨三叉神经痛患者三叉神经体感诱发电位（TSEP）的波形特征,临床价值以及手术和药物对TSEP的影响。方法：采用丹麦产DISA—2000M多导诱发肌电仪,对45例原发性三叉神经痛患者进行健侧和患侧的TSEP检查,以正常人TSEP数据作为对照,对结果进行对比分析。结果：（1）原发性三叉神经痛患者的健侧患侧比较,潜伏期N1、P3、N3及波幅N2P3、N3P4差异明显,有统计学意义（P〈0.05）。患者与健康者比较,潜伏期P1、N1、P2、N2、P3及波幅P1N1、N1P2、P2N2、N2P3、N3P4差异明显,有统计学意义（P〈0.05）。（2）原发性三叉神经痛患者TSEP高幅电位提前,潜伏期延迟。（3）手术后TSEP波形消失,药物对TSEP影响不大。结论：潜伏期N1、P3的延迟及波幅N2P3的升高,N3P4的降低可以作为原发性三叉神经痛的诊断标准。