硬膜外腔注药治疗腰椎间盘突出致坐骨神经痛

目的研究硬膜外腔注药治疗腰椎间盘突出致坐骨神经痛的临床效果和治疗机制。方法腰椎间盘突出致坐骨神经痛患者862例按入院时间先后分为单纯硬膜外腔注射组和硬膜外腔注射加手法组。治疗前后比较临床症状、皮肤温度和影像学表现变化。结果手法并硬膜外腔注射组优于单纯硬膜外腔注射治疗组。15例急性发病患者,治疗前平均值为(35.21±0.23)℃,治疗后平均值为(36.42±0.51)℃,20例慢性发病者,治疗前平均值为(34.81±0.41)℃,治疗后平均值为(35.03±0.26)℃,治疗前两组进行t检验,t=10.53,35,P<0.01,差异有显著性意义。治疗后两组进行t检验,t=3.39,P<0.05,差异有显著性意义。两组患者皮肤温度平均较治疗前提高1.5℃。硬膜外腔注射组中68例治愈后3～6个月内CT扫描45例,MRI成像23例,发现腰椎管及间盘突出物的形态与治疗前无显著变化。结论硬膜外腔注射治疗腰椎间盘突出致坐骨神经痛患者效果较好,加用手法治疗可以提高疗效。

Epidura space injection therapy on patients with sciatica caused by prolapse of lumbar intervertebral disc

AIM:To study the mechanism and clinical effect of epidural space injection therapy on patients with pain caused by prolapse of lumbar intervertebral disc. METHODS:862 patients were divided into two group patients according to sequence of time.One group was treated only with epidural space injection therapy and the other group was treated with both epidural space injection therapy and manipulation.The temperatures changes of buttock and posterior femur cutaneous were measured by infrared thermal scanner and changes of CT or MRI image were also observed.Then they were compared before and after treatment. RESULTS:The group treated with both epidural space injection therapy and manipulation had better curative effect than the group treated only with epidural space injection therapy.After treatment,skin temperature of sick lateral buttock and posterior femur cutaneous of 15 patients with acute attack was averagely( 35.21± 0.23)℃ before treatment and ( 36.42+ 0.51)℃ after treatment.And that of 20 patients with chronic attack was averagely( 34.81± 0.41)℃ before treatment and ( 35.03± 0.26)℃ after treatment. There was obvious significance between two groups(t=10.53,35,P< 0.01) after t test.And there was still obvious significance between two groups(t=3.39,P< 0.05) after t test.The skin temperature of patients in both groups improved averagely 1.5 ℃ than that before treatment.45 of 68 patients were given CT scanning 3 to 6 months after recovery and another 23 cases were given MRI image.It was found that there were no significant difference in form of lumbar spinal canal and protrusion of intervertebral disc. CONCLUSION:Epidural space injection therapy has better effect on treating patients with sciatica caused by prolapse of lumbar intervertebral disc and the effect can be improved combined with manipulation.