微创联合针刀松解术治疗椎间盘源性下腰痛疗效分析

目的 探讨微创联合针刀松解术治疗椎间盘源性下腰痛的疗效.方法 回顾性分析2009年10月至201 1年10月因下腰痛采用经皮臭氧腰椎间盘髓核化学溶解术32例患者(对照组)和该术结合针刀松解术治疗30例患者(观察组)的临床资料.对照组患者仅采用经皮腰椎间盘髓核化学溶解术治疗,观察组在对照组治疗的基础上,透视下对责任椎间盘节段软组织粗条索状改变及不规则结节处行针刀松解术.术后1周、6个月根据视觉模拟评分(VAS)、改良Macnab法进行疗效评定.结果 2组患者均完成随访.2组患者治疗后1周、6个月VAS均明显低于治疗前对照组:(2.4±1.2)、(2.4±1.6)分比(5.4±1.2)分；观察组:(2.0±1.1)、(1.6±1.2)分比(5.3±1.3)分],差异均有统计学意义(均P＜0.01)；术后1周观察组与对照组间差异无统计学意义(P＞0.05),术后6个月观察组明显低于对照组,差异有统计学意义(P＜0.05).对照组治疗后6个月优良率为65.6％ (21/32),观察组优良率为76.7％(23/30),组间优良率比较,差异有统计学意义(P＜0.05).结论 经皮微创治疗腰椎间盘源性下腰痛安全、可行,结合针刀松解术疗效显著.

Effect of minimally invasive surgery combined with the needle knife surgery on discogenic low back pain

Objective To explore the effects of traditional Chinese medicine combined with the minimally invasive on discogenic low back pain. Methods The data of 62 patients with low back pain were retrospectively analyzed. All 62 cases with lumbar discogenic low back pain were randomly divided into 2 groups ： control group （ percutaneous lumbar nucleus pulposus chemical lysis, 32 cases） and observation group （percutaneous lumbar nucleus pulposus chemical lysis combined with needle knife technique, 30 cases）. After 1 week and 6 months after opera- tion, the effects in 2 groups were evaluated by visual analogue scale （VAS） and modified Macnab method. Results One week and six months after operation, the VAS values in 2 groups were less than those before treatment control group： （2.4 ± 1.2）, （ 2.4 ± 1.6） scores vs （5.4 ±1.2） scores ; observation group ： （2.0 ± 1.1 ）, （ 1.6 ± 1.2 ） scores vs （5.3 ± 1.3 ） scores ] , and there was a significant difference （ P 〈 0.01 ）. One week after op- eration, there was no significant difference of the VAS values between observation group and control group （P 〉 0. 05） ; 6 months after operation, the VAS values in observation group were less than that in control group （P 〈 0. 05）. After 6 months, the recovery rates in control group and observation group were 65.6% （21/32） and 76.7% （23/30） %, and the difference was statistically significant （P 〈 0.05）. Conclusions Minimally invasive percutaneous treatment of lumbar discogenic low back pain is a safe and feasible method. The combination of needle knife surgery can achieve a significant effect.