中国组织工程研究

中国组织工程研究 ›› 2013, Vol. 17 ›› Issue (48): 8449-8454.doi: 10.3969/j.issn.2095-4344.2013.48.024

• 骨与关节临床实践 clinical practice of the bone and joint • 上一篇    下一篇

CT引导下经皮介入及康复一体化治疗腰椎间盘突出症

戴德纯1，童国海2，边联龙3，唐春林1，朱伟芳1，梅麟凤1，石长根1，姜  浩1，杭方杰1   

  1. 昆山市中医医院，南京中医药大学附属昆山医院，1康复科，3放射科，江苏省昆山市  215300；2上海交通大学附属瑞金医院放射科，上海市  200025
  • 出版日期:2013-11-26 发布日期:2013-11-26
  • 通讯作者: 戴德纯，昆山市中医医院康复科，南京中医药大学附属昆山医院康复科，江苏省昆山市 215300 dechundai@gmail.com
  • 作者简介:戴德纯☆，男，1973年生，江苏省姜堰市人，汉族，2007年上海中医药大学毕业，博士，副主任中医师，主要从事脊柱相关疾病和慢性疲劳综合征的中西医结合康复治疗。 dechundai@gmail.com

CT-guided percutaneous intervention combined with rehabilitation integration treatment for lumbar disc herniation

Dai De-chun1, Tong Guo-hai2, Bian Lian-long3, Tang Chun-lin1, Zhu Wei-fang1, Mei Lin-feng1, Shi Chang-gen1, Jiang Hao1, Hang Fang-jie1   

  1. 1Department of Rehabilitation, Kunshan Hospital of TCM, Kunshan Hospital Affiliated to Nanjing University of Chinese Medicine, Kunshan  215300, Jiangsu Province, China; 2Department of Radiology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University, Shanghai  200025, China; 3Department of Radiology, Kunshan Hospital of TCM, Kunshan Hospital Affiliated to Nanjing University of Chinese Medicine, Kunshan  215300, Jiangsu Province, China
  • Online:2013-11-26 Published:2013-11-26
  • Contact: Dai De-chun, M.D., Associate chief physician, Department of Rehabilitation, Kunshan Hospital of TCM, Kunshan Hospital Affiliated to Nanjing University of Chinese Medicine, Kunshan 215300, Jiangsu Province, China dechundai@gmail.com
  • About author:Dai De-chun☆, M.D., Associate chief physician, Department of Rehabilitation, Kunshan Hospital of TCM, Kunshan Hospital Affiliated to Nanjing University of Chinese Medicine, Kunshan 215300, Jiangsu Province, China dechundai@gmail.com

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493

被引次数

6

摘要：

背景：CT引导下经皮介入和传统特色康复技术皆为腰椎间盘突出症临床诊疗的经典方案，二者的糅合是否有助于患者功能恢复，取得较好的临床干预结局？
目的：评估CT引导下经皮药物介入结合康复一体化治疗腰椎间盘突出症的临床疗效，探讨影响疗效的相关因素。
方法：于2010年5月至2013年5月，对88例腰椎间盘突出症患者行CT引导下经皮药物介入结合康复一体化治疗。药物由复方倍他米松、丹参酮ⅡA磺酸钠、神经妥乐平、生理盐水和碘海醇等组成，康复综合治疗包括牵引、推拿、针灸、经皮神经电刺激和磁振热疗法。疗效评价采用Macnab标准和汉化Oswestry功能障碍指数(ODI)。并与先前报道的112例单纯CT引导药物介入治疗的临床疗效进行统计学比较。采用关联分析探讨年龄分组、病程分期、椎间盘突出节段分型等对疗效结局的影响。
结果与结论：1年随访77例患者，其中优64例，良7例，可5例，差1例，结局优良率占92%。术后1个月、6个月和1年随访与治疗前比较，患者改良Oswestry功能障碍指数各条目及总分有逐渐降低的趋势，差异有显著性意义(P  < 0.01)。纳入患者未见严重并发症发生。药物介入结合康复组与单纯药物介入组相比结局优良率有提高的趋势，但差异尚无显著性意义(P  > 0.05)。与>45岁组比较，患者年龄≤45岁可取得较好的临床疗效，组间比较差异有显著性意义(P < 0.01)。病程长短、椎间盘突出的形态、单节段和多节段突出与疗效结局尚无明确的关联性(P  > 0.05)。结果表明CT引导下经皮药物介入结合康复一体化治疗可有效缓解腰椎间盘突出症患者腰背痛及下肢放射痛症状，降低生活功能障碍程度。

关键词: 骨关节植入物, 骨与关节临床实践, CT引导经皮穿刺, 腰椎间盘突出症, 一体化治疗, 汉化Oswestry功能障碍指数

Abstract:

BACKGROUND: CT-guided percutaneous intervention and rehabilitation techniques are both classic programs for diagnosis and treatment of lumbar disc herniation. Is the combination of CT-guided percutaneous intervention and rehabilitation techniques preferentially used for treatment of lumbar disc herniation?
OBJECTIVE: To evaluate the curative effect of CT-guided interventional injection combined with rehabilitation integration treatment for lumbar disc herniation and to analyze prognostic factors.
METHODS: Eighty-eight patients with lumbar disc herniation were subjected to CT-guided interventional injection combined with rehabilitation integration treatment from May 2010 to May 2013. Injection medicine consisted of betamethasone, tanshinone Ⅱ A sulfonate, neurotropin, normal saline and iohexol. Rehabilitation integration treatment included traction, manipulation, acupuncture, transcutaneous electrical nerve stimulation and thermal magnon. Macnab criteria and Chinese version of Oswestry low back pain disability questionnaire were used to assess the curative effects in comparison with the 112 patients receiving only CT-guided interventional injection that were reported previously. The prognostic factors, such as age, disease course time and herniation type of target segment were testified by correlation analysis.
RESULTS AND CONCLUSION: Totally 77 patients were completely followed up for 1 year. There were excellent outcomes in 64 cases, while favorable outcomes in 7 cases, fair outcomes in 5 case, poor outcome in 1 case, with a better outcome rate of 92%.There was a significantly decreased trend in Oswestry disability Index scores at 1, 6, 12 months during the follow-ups (P < 0.01). No severe complications occurred in all the included patients. The curative effects were improved in term of better outcomes rate compared with the 112 patients receiving only CT-guided interventional injection, but there was no significant difference (P  > 0.05). The young group (≤ 45 years) had better outcomes than the older group (> 45 years; P  < 0.01). In addition, disease course time and herniation type of target segment were not statistically significant risk factors predicting clinical results (P  > 0.05). These findings indicate that CT-guided interventional injection combined with rehabilitation integration treatment could relieve lower back pain and radical leg pain effectively and decrease life disability level.

Key words: lumbar vertebrae, intervertebral disk displacement, drug therapy, rehabilitation, treatment outcome

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