射频热凝加小针刀松解治疗腰骶部疼痛与单一方法的比较

目的 探讨行脊神经后支射频热凝加腰三横突小针刀松解在腰骶部疼痛治疗中的疗效，并与单一方法对比。方法 80例患者分为A组(单纯神经阻滞)，B组(神经阻滞+小针刀松解术)，C组(神经阻滞+射频治疗)，D组(神经阻滞+小针刀松解术+射频治疗)，每组20例。根据腰椎正侧位片，采用双侧椎弓根测量定位法，分别标志患侧第三腰椎横突尖部及脊神经后支相应的邵氏压痛点在体表的定位。腰三横突尖部行针刀松解；脊神经后支感觉、运动定位测定后，给予80℃．60s的射频治疗，共2个射频周期。观察视觉模拟评分法(VAS)，记录治疗前、治疗后即时、24h。2周：静止VAS、运动VAS、腰三横突压痛VAS、邵氏点压痛VAS。组间比较用完全随机设计的方差分析，两两比较用SNK．口检验。结果 D组在24h、2周与A、B、C组的比较P&;lt;0．05差异有统计学意义；B组在腰三横突压痛VAS与A组的比较P&;lt;0．05差异有统计学意义；C组与A组在邵氏点压痛VAS的比较P&;lt;0．05有统计学意义。结论 慢性腰骶部疼痛，在诊断明确时，治疗上利用射频热凝加针刀松解联合施治，较单一方法好。     

射频热凝腰脊神经后支治疗腰痛的临床研究

选择32例腰痛患者，均经物理治疗、中西药物治疗效果不佳．采用邵振海的腰痛神经定位法．经皮穿刺将射频针刺入损伤的腰脊神经后支处，射频热凝腰省神经后支．结果：32例患者中有27例取得明显的治疗效果．提示射频热凝腰省神经后支是治疗腰痛的一种有效方法。并对此种治疗方法的并发症、治疗机理及适应症的选择进行了探讨。     

热凝与无水乙醇注射治疗三叉神经痛的效果比较

目的观察热凝治疗三叉神经痛的疗效及副作用,并与无水乙醇治疗的效果相比较。方法选择30例三叉神经痛患者,经药物控制无效者。分为两组,每组15例。A组,在三叉神经的神经干走行处注射无水乙醇0.3mL。B组,在三叉神经的神经干走行处用RCG-3F(美国产)进行射频热凝治疗70,75,80,85℃各1次,90s/次。术后1周观察患者疼痛缓解程度(VAS法),随访其疼痛缓解时间、面部麻木感恢复时间。结果术后1周B组患者疼痛缓解程度(0.2±0.1)分,A组(1.5±0.6)分,与A组比差异有非常显著性意义(t=7.056,P<0.01),B组患者疼痛缓解时间(7.8±0.5)个月,A组(5.3±0.8)个月,与A组比差异有显著性意义(t=2.328,P<0.05),B组患者面部麻木感恢复时间(2.5±0.3)个月,明显快于A组(5.8±0.9)个月,与A组比差异有非常显著性意义(t=3.782,P<0.01)。结论热凝治疗三叉神经痛明显优于无水乙醇注射法。     

经皮射频热凝腰脊神经后支在腰痛中的应用

腰痛的病因复杂,任何疼痛的来源均有其神经支配的结构基础,阻滞该支配神经不仅可以止痛并可达到定位的目的。有关脊神经后支的行径及分布的研究,发现腰痛的部位与后支有密切的神经联系。现介绍腰脊神经后支损伤性腰痛的诊断方法及应用经皮射频电凝腰脊神经后支治疗腰痛的具体步骤,并对腰脊神经后支与腰痛的关系进行了探讨,对射频电凝腰脊神经后支治疗腰痛的方法进行了机理分析,提示射频电凝腰脊神经后支是治疗腰痛的一种有效治疗方法,值得在临床应用推广。     

经皮射频热凝腰脊神经后支在腰痛中的应用

腰痛的病因复杂，任何疼痛的来源均有其神经支配的结构基础，阻滞该支配神经不仅可以止痛并可达到定位的目的。有关脊神经后支的行径及分布的研究，发现腰痛的部位与后支有密切的神经联系。现介绍腰脊神经后支损伤性腰痛的诊断方法及应和经皮射频电凝腰脊神经后支治疗腰痛的具体步骤，并对腰脊神经后支与腰痛的关系进行了探讨，对射频电凝腰脊神经后支治疗腰痛的方法进行了机理分析，提示射频电凝腰脊神经后支是治疗治疗腰痛的一种有效治疗方法，值得在临床应用推广。     

髓核减压结合脊神经后支射频热凝治疗盘源性下腰痛

目的:评价腰椎间盘髓核减压结合脊神经后支热凝治疗盘源性下腰痛的有效性。方法:80例明确诊断为盘源性下腰痛的患者随机分为两组,治疗组(A组,n=40)行髓核钳夹减压术结合脊神经后支射频热凝术。对照组(B组,n=40)单纯采用髓核减压术治疗;手术效果按照疼痛视觉类比评分(Visual Analogue Scale,VAS)和改良的MacNab标准评定,记录两组术中异常情况、不良反应及术后随访满意度。结果:所有病例均顺利完成手术。根据改良的MacNab标准评估后,A组的有效率达90.0%,明显高于对照组的80.0%,差异具有统计学意义(P<0.05)。治疗后3天和3个月后患者的VAS评分与治疗前相比,治疗组及对照组均明显降低,差异有显著性意义(P<0.05);而治疗组与对照组相比,VAS下降更明显,差异也有显著性意义(P<0.05)。结论:腰椎间盘髓核减压术结合脊神经后支射频热凝治疗盘源性下腰痛疗效更好,而且无明显不良反应发生。     

射频热凝及冷冻治疗腰脊神经后支综合征

目的观察射频热凝、冷冻及神经阻滞方法的临床疗效及并发症,探讨更安全有效的治疗措施。方法腰脊神经后支综合征患者202例,按随机数字表分为3组,分别给予射频热凝、冷冻和常规神经阻滞治疗。结果(1)视觉模拟评分(VAS)评估疼痛程度:治疗1周后射频热凝、冷冻组VAS评分较治疗前明显降低,分别为5.1±1.2,4.0±1.1,改善程度均优于神经阻滞组(t1=3.79,P<0.001;t2=3.42,P<0.001);二组间VAS评分改善程度无显著性差异。(2)副反应:射频热凝组副反应发生率明显低于冷冻组和神经阻滞组。结论射频热凝及冷冻治疗腰脊神经后支综合征,疗效确切,操作简单,并发症少。     

颈后肌筋膜疼痛综合症射频热凝治疗

目的:总结射频热凝治疗颈后肌筋膜疼痛综合症的临床效果.方法:32例颈后肌筋膜疼痛综合症患者,以颈后肌群压痛点为穿刺点,穿刺针抵达骨质后,调节热凝温度为75℃,时间为30秒,行穿刺点射频热凝;观察治疗前、治疗后1周、1月和3个月VAS评分、疼痛缓解优良率和镇痛药使用情况.结果:治疗前、治疗后1周、1月和3个月VAS评分分别是8.1±0.9、7.3±1.2、3.8±1.1、1.5±1.2;疼痛程度在治疗后1个月和3个月均较治疗前有明显缓解(P＜0.01);治疗后1周内使用止痛药人次为85%,1个月后为10%(P＜0.05),3个月后全部停止痛药.结论:射频热凝治疗颈肌筋膜疼痛综合症创伤微小、安全和疗效确切.     

腰骶部脊神经后根脉冲射频术的穿刺路径

目的:探索一种腰骶部脊神经后根脉冲射频的穿刺径路,观察脉冲射频治疗根性腰腿痛的效果。方法:选择2003/2005深圳市南山人民医院疼痛诊疗中心收治的根性腰腿痛的患者68例。根据小关节内侧缘穿刺是抵达侧隐窝的最短距离,以及腰骶部脊神经后根在椎管内的解剖学特点,选择小关节内侧缘入路寻找脊神经后根。经精确测量,准确定位后(部分患者在数字减影血管造影或CT引导下)用射频针进行穿刺,到达侧隐窝后开启射频机,通过电刺激诱发出病变区的疼痛,判断针尖靠近脊神经后根时进行脉冲射频治疗,采用脉冲射频模式(2次/s,20ms/次,维持42℃,120s的周期)进行治疗,持续两个周期。术后观察不良事件,术前和术后2个月评估目测类比评分,计算疼痛缓解率。结果:68例患者均进入结果分析。①68例穿刺成功,3例造影患者显示造影剂分布于侧隐窝,2例CT下穿刺显示针尖靠近神经根。②术后2个月疼痛缓解率达50%的患者49例(72%),未发现肌力减退、皮肤的麻木等不良事件。结论:精确测量、准确定位后经小关节内缘穿刺入路抵达脊神经后根的方法是可行的,腰骶部背根神经(节)的脉冲射频治疗根性腰腿痛的近期疗效是肯定和明显的。     

HCPT电凝法治疗混合痔30例

混合痔是肛肠科常见病,多发病。对其治疗方法多样。我科于2009年11月至2010年5月,采用肛肠治疗仪(HCPT)治疗混合痔30例,疗效满意。并且与混合痔外剥内扎术进行对比观察,现报告如下:资料和方法     

Correlations between pain and function in a longitudinal low back pain cohort

Purpose.?Most studies of low back pain (LBP) and functional limitation have been cross-sectional, and show only modest correlations between pain and function. Though functional limitation may be superior for predicting disability outcomes, there is a need to understand better the gap between pain and function. This study analysed changes in intra-individual correlations between pain and function over time.

Method.?Seventeen men and 16 women currently experiencing LBP provided self-reports of LBP (0-to-10 scale) and functional status (Back Pain Functional Scale) for a maximum of 8 weeks. Spearman correlation coefficients between pain and function scores were calculated for each individual. The effects of pain history, pain intensity, variability and trends over time on pain–function correlations were assessed.

Results.?There were no significant differences in correlation due to gender, age or pain intensity (low versus high). Participants with steeper slopes in change in pain score over the study period had significantly stronger correlations to function than those with weaker trends, r?==??0.91 and r?==??0.45, respectively. Participants with at least one pain-free score during the reporting period had significantly stronger correlations than those with no pain-free reports, r?==??0.80 and r?==??0.51, respectively. Participants having the first episode LBP had stronger correlations (r?==??0.85) than those with persistent symptoms of LBP (r?==??0.62).

Conclusions.?The results suggest that over the course of LBP, within-person pain–function correlations are stronger than those reported in cross-sectional, population-based studies. Changes in pain ratings over time may have more clinical relevance than differences in pain levels between individuals. Among those with more long-standing pain, factors other than pain intensity, such as pain catastrophising or fear avoidant beliefs, may have a greater effect on day-to-day perceptions of functional limitation.     

护理人员腰背疼痛与抑郁情绪的相关性研究

目的探讨护理人员腰背疼痛(low back pain,LBP)与抑郁情绪之间的相关关系。方法采用一般情况、数字疼痛量表(numerical rating scale,NRS)及Beck抑郁问卷(Beck depression inventory,BDI)对502名临床在职护理人员进行调查。按有无LBP分为LBP组和无LBP组。采用χ2检验、秩和检验及等级相关分析法分析LBP与抑郁情绪间的相关关系。结果与无LBP组比较,LBP组BDI指数明显升高。LBP发生率及疼痛程度与抑郁程度呈正相关。结论做好躯体症状和心理症状双重干预可降低护理人员LBP的发生。     

Relationships between demographic, clinical and pain variables and health-related quality of life in patients with chronic low back pain treated with instrumented fusion

The purpose of this cross-sectional study was to assess the relationships between demographic, clinical and pain variables and health-related quality of life (HRQOL) in patients who had undergone instrumented spinal fusion because of chronic low back pain (CLBP). The sample comprises 101 patients (70% women, mean age 46 years) who had received surgery between 1993 and 2000. The SF-36 Health Survey was used to assess HRQOL. Pain was assessed by sensory, affective and evaluative subgroups of the Norwegian Pain Questionnaire (modified McGill Pain Questionnaire). Age, work status, number of years after surgery, physical training, other chronic conditions and affective and evaluative pain (all p < 0.05) were the most prominent factors affecting HRQOL. The highest adjusted R(2) to explain the variance was physical function (52%) and the lowest was emotional role limitations (15%). Pain, particularly affective and evaluative pain, contributed more to the explained variance of HRQOL than demographic and clinical variables.     

小针刀综合治疗对慢性下腰痛患者腰屈曲活动度及生存质量的影响

目的:观察小针刀治疗对慢性下腰痛患者腰屈曲活动度和生存质量的影响。方法:将265例下腰痛患者随机分为两组,Ⅰ组为对照组(132例),采用超短波、调制中频电、推拿及功能训练治疗。Ⅱ组为针刀组(133例),采用小针刀,辅以封闭和功能训练,两组治疗前后均测量腰屈曲活动度,并采用改良的Oswestry腰痛问卷进行评分,以评定生存质量。结果:针刀组患者治疗后腰屈曲活动度明显改善且Oswestry腰痛问卷评分分值明显下降,与对照组比较,差异均有显著性意义(P<0.01)。两组患者随访6—48个月,平均随访10.85±5.74个月,针刀组疗效稳定,与对照组比较,差异有显著性意义(P<0.01)。结论:小针刀治疗可明显改善慢性下腰痛患者腰屈曲活动度及生存质量,且远期疗效稳定。     

Correlation between change in pain,disability, and surface electromyography topographic parameters after interferential current treatment in patients with chronic low back pain

[Purpose] Surface electromyography (SEMG) topography is used to objectively assess patients with low back pain (LBP). This study aimed to investigate the correlation between SEMG topographic variables, pain, and disability in patients with chronic LBP (CLBP) after interferential current (IFC) treatment, and to evaluate IFC treatment efficacy using SEMG topography. [Participants and Methods] Twenty nine patients with CLBP were recruited for a 6-week IFC treatment. Pain and disability scores, and the root-mean-square difference (RMSD) of SEMG topographic variables (relative areas [RAs] at flexion and extension) were compared before and after the intervention by repeated measures ANOVA; the correlation between variables was also explored and p-value was set at 0.001. [Results] Significant positive correlations between changes in pain score and the RMSD of RA at flexion (r(29)=0.593), and between changes in pain and disability scores (r(29)=0.426) were observed. All participants showed statistically significant improvements in the RMSD of RA at flexion, pain score, and disability score after IFC treatment. [Conclusion] SEMG topographic variables are closely associated with changes in pain score in patients with CLBP after IFC treatment. The RMSD of RA at flexion can be used as an objective marker in IFC treatment efficacy evaluation.     

The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy

The aim of this study was to determine the extent to which a number of distinct cognitive factors were differentially related to the levels of pain and disability reported by 183 chronic low back pain (CLBP) patients presenting for physiotherapy. After adjusting for demographics, the cognitive factors accounted for an additional 30% of the variance in pain intensity, with functional self-efficacy (beta=-0.40; P<0.001) and catastrophizing (beta=0.21; P<0.01) both uniquely contributing to the prediction of outcome. The cognitive factors also explained an additional 32% of the variance in disability after adjusting for demographics and pain intensity (total R(2)=0.61). Higher levels of functional self-efficacy (beta=-0.43; P<0.001) and lower levels of depression (beta=0.23; P<0.01) were uniquely related to lower levels of disability. Our findings clearly show that there is a strong association between cognitive factors and the levels of pain and disability reported by CLBP patients presenting for physiotherapy. Functional self-efficacy emerged as a particularly strong predictor of both pain intensity and disability. In view of our findings it would seem that targeting specific cognitive factors should be an integral facet of physiotherapy-based treatments for CLBP.     

The relationship between self-efficacy and disability in chronic low back pain patients

This study examined the reliability of an adapted version of the Arthritis Self-Efficacy Scale in a sample of 59 chronic low back pain patients. The present study also investigated the relationship between self-efficacy and measures of disability. Regression analyses indicated a significant negative relationship between self-efficacy and low back pain disability. That is, patients who report higher levels of self-efficacy have higher activity levels (R ²=0.34,P<0.01), work more hours (R ²=0.25,P<0.01), and have lower levels of psychological distress (R ²=0.29,P<0.01), pain severity (R ²=0.46,P<0.01), and pain behavior (R ²=0.27,P<0.01) after controlling for the demographic variables of gender, duration of back pain, and having a lawyer on retainer. The results support the use of the Back Pain Self-Efficacy Scale (BPSES) as a general measure of self-efficacy in the chronic low back pain population.