脉络宁硬膜外自控式注射配合手法治疗腰椎间盘突出症

目的探索脉络宁硬膜外腔自控式注射配合推拿牵引等手法综合治疗腰椎间盘突出症(LIDH)的疗效。方法选择符合纳入标准的LIDH患者156例,随机将患者分为4组:推拿牵引手法治疗组(TMM组,n=38)、脉络宁硬膜外注射+手法治疗组(MET组,n=40)、脉络宁硬膜外自控式注射+手法治疗组(MPT组,n=36)及西药硬膜外自控式注射+手法治疗组(WPT组,n=42)。分别记录4组治疗前与每个疗程后1 d、总疗程后1个月的疼痛视觉模拟评分(VAS)值;记录治疗前和治疗后1、3个月Oswestry功能障碍指数(ODI)分值,进行ODI疗效评价,并计算优良率及有效率。结果 MET、MPT、WPT 3组患者每个疗程结束后1 d及总疗程后1个月进行VAS值测定均比TMM组降低(P<0.01或<0.05),治疗后1、3个月临床疗效评定有效率及优良率均优于TMM组(P<0.01或<0.05),但MPT、WPT组更佳(P<0.01),且疗效稳定。结论脉络宁硬膜外自控式注射配合推拿牵引等手法治疗LIDH,可使治疗周期缩短、避免多次应用类固醇激素药,且疗效稳定,该方法是其他保守疗法效果不佳又惧怕手术的LIDH患者的一种良好选择。

Treatment of lumbar intervertebral disc herniation by patient-controlled epidural analgesia with Mailuoning injection combined with manipulation

Objective To explore the advantages and the effectiveness of patient-controlled epidural analgesia(PCEA) with Mailuoning injection combined with manipulation in treatment of lumbar intervertebral disc herniation(LIDH).Methods One hundred and fifty-six patients(93 male and 63 female)with LIDH diagnosed and treated in the department of Pain or Orthopedics and Traumatology were selected between July 2008 and March 2010 aged 20-65 years,the course of disease was from 6 to 12 months.All the patients were informed and agreed the treating plans.They were randomly divided into four groups: group TMM(n=38) was treated with traction manipulation massage,group MET(n=40) with epidural analgesia(EA) with Mailuoning injection combined with traction manipulation massage,group MPT(n=36) with PCEA with Mailuoning injection combined with traction manipulation massage,group WPT(n=42) with PCEA with western medicine injection combined with traction manipulation massage.One week was used as a treatment course and all the patients accepted for 4 weeks.Vision analog score(VAS) was estimated at the beginning,1 day after each course and 1 month after 4 courses.The levels of Oswestry disability index(ODI) were also recorded and evaluated at the beginning,the end of the 1st and 3rd month in the study.The excellent rate and total effective rate of all groups were calculated.Measure and count datums were compared by t test and Chi-square test.Results The patients among group MET,MPT and WPT had an obvious decrease of VAS at 1 day after each course and 1 month after 4 courses,there were significantly lower than group TMM(P<0.01 or P<0.05).The excellent rate and total effective rate of group MET,MPT and WPT were significantly higher than group TMM(P<0.01 or P< 0.05),but the result of group MPT and WPT were better and more stable(P<0.01).No apparent side effect was observed in all patients accepted treatment.Conclusions PCEA with Mailuoning injection combined with traction manipulation massage in treatment of LIDH is safe and effective,it can manifestly shorten the course of the disease and decrease the dosage of glucocorticoid.This method is a good alternative to the patients with LIDH who are not benefited from other conservative treatments or afraid of operations.