本文選題：神經(jīng)松解 + 神經(jīng)妥樂平��； 參考：《廣東醫(yī)學(xué)》2017年18期

【摘要】：目的探討臀上、臀中皮神經(jīng)松解聯(lián)合神經(jīng)妥樂平封閉治療腰椎間盤突出癥(LDH)術(shù)后殘余神經(jīng)痛的臨床效果。方法選取LDH術(shù)后殘余神經(jīng)痛患者120例作為研究對(duì)象。按隨機(jī)數(shù)字表法分為3組,對(duì)照組(n=40)、試驗(yàn)A組(n=40)和試驗(yàn)B組(n=40)。對(duì)照組術(shù)后給予生理鹽水痛點(diǎn)封閉治療,試驗(yàn)A組術(shù)后給予骶管封閉+利多卡因+神經(jīng)妥樂平痛點(diǎn)封閉治療,試驗(yàn)B組術(shù)后給予小切口行臀上及臀中皮神經(jīng)松解封閉+利多卡因+神經(jīng)妥樂平痛點(diǎn)封閉治療。采用視覺模擬評(píng)分法(VAS)評(píng)估3組患者治療前、治療后2、8、16及24周腰腿痛程度,并比較治療后3個(gè)月3組患者腰腿痛癥狀緩解優(yōu)良情況,3組患者治療后直腿抬高試驗(yàn)及加強(qiáng)試驗(yàn)陽性率,同時(shí)比較3組患者負(fù)重行走500 m及久坐1 h腰腿痛發(fā)生率。結(jié)果治療前3組患者VAS評(píng)分相比差異無統(tǒng)計(jì)學(xué)意義(P0.05),且3組患者治療后2、8、16及24周VAS評(píng)分均呈下降趨勢(shì),但試驗(yàn)A組和試驗(yàn)B組VAS評(píng)分均低于對(duì)照組,試驗(yàn)B組VAS評(píng)分低于試驗(yàn)A組,差異有統(tǒng)計(jì)學(xué)意義(P0.05);試驗(yàn)B組治療后腰腿痛癥狀緩解優(yōu)良率明顯優(yōu)于試驗(yàn)A組及對(duì)照組(P0.05);治療前3組患者直腿抬高試驗(yàn)及加強(qiáng)試驗(yàn)陽性率相比差異無統(tǒng)計(jì)學(xué)意義(P0.05);試驗(yàn)B組治療后直腿抬高試驗(yàn)及加強(qiáng)試驗(yàn)陽性率明顯優(yōu)于試驗(yàn)A組及對(duì)照組(P0.05);治療后3個(gè)月試驗(yàn)B組患者負(fù)重行走500 m及久坐1 h腰腿痛發(fā)生率分別為12.50%、10.00%明顯均低于試驗(yàn)A組的32.50%、30.00%以及對(duì)照組的42.00%、40.00%(P0.05)。結(jié)論臀上、臀中皮神經(jīng)松解聯(lián)合神經(jīng)妥樂平封閉治療LDH術(shù)后殘余神經(jīng)痛患者能有效改善患者殘留的疼痛感,緩解腰腿痛癥狀,術(shù)后療效顯著,值得在臨床上進(jìn)一步推廣。
[Abstract]:Objective to investigate the clinical effect of supragluteal and middle gluteal neurolysis combined with neurotropin blocking in the treatment of residual neuralgia after lumbar disc herniation (LDH). Methods 120 patients with residual neuralgia after LDH were selected. According to the method of random number table, the control group was divided into 3 groups: control group (n = 40), group A (n = 40) and group B (n = 40). The control group was treated with normal saline after operation, and group A was treated with sacral canal closure of lidocaine and neuropathic points after operation. In group B, small incision was given for the treatment of superior gluteal and middle gluteal nerve release and closure of Lidocaine. Visual analogue score (VASA) was used to evaluate the degree of low back and leg pain in 3 groups before and 2 weeks after treatment. The positive rates of straight leg elevation test and strengthening test were compared 3 months after treatment, and the incidence of lumbago and leg pain after walking 500 m and sitting for 1 hour were compared. Results there was no significant difference in VAS scores between the three groups before treatment (P 0.05), and the VAS scores of the 3 groups showed a downward trend at the 2nd week and 24th week after treatment, but the VAS scores in the trial group A and group B were lower than those in the control group. The VAS score of group B was lower than that of group A. The difference was statistically significant (P 0.05), the excellent and good rate of relieving low back and leg pain in group B was significantly better than that in group A and control group, and there was no significant difference in the positive rate of straight-leg elevation test and intensive test in three groups before treatment. The positive rate of straight leg raising test and strengthening test in group B was significantly higher than that in group A and control group, and the incidence of lumbago and leg pain in group B was 12.50% and 10.00% respectively 3 months after treatment. It was lower than that of group A (32.50%) and control group (42.00%) (P 0.05). Conclusion treatment of residual neuralgia in patients with residual neuralgia after LDH can improve the sense of residual pain and relieve the symptoms of lumbago and leg pain effectively. The curative effect of the treatment is remarkable and worthy to be popularized in clinical practice.
【作者單位】： 承德醫(yī)學(xué)院附屬醫(yī)院脊柱外一科;承德醫(yī)學(xué)院附屬醫(yī)院眼科;承德醫(yī)學(xué)院附屬醫(yī)院關(guān)節(jié)外科;圍場(chǎng)滿族蒙古族自治縣中醫(yī)院;圍場(chǎng)滿族蒙古族自治縣醫(yī)院骨科;
【基金】：承德市科學(xué)技術(shù)研究與發(fā)展計(jì)劃項(xiàng)目(編號(hào):20151043)
【分類號(hào)】：R687.3

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