【摘要】：目的:經(jīng)椎間孔選擇性神經(jīng)根阻滯術(Transforaminal selective nerve root block)是運用靶點穿刺技術直達病灶解決病痛;虛痹方是我院林一峰教授在"溫養(yǎng)督脈理論"的基礎上自擬的臨床經(jīng)驗方。本文通過臨床癥狀、實驗室檢查等指標觀察,客觀的評價兩種治療方案的臨床療效,為臨床治療腰椎間盤突出癥提供最佳的治療方案。方法:選取2015年2月～2016年2月在廣州中醫(yī)藥大學第三附屬醫(yī)院脊柱骨科將符合研究條件的72例患者納入研究,在簽署《患者治療方案知情同意書》的基礎上將患者隨機分為2組;試驗A組:經(jīng)椎間孔選擇性神經(jīng)根阻滯術+脊柱科常規(guī)路徑治療;試驗B組:虛痹方(服用療程4個療程,1個療程1周)+脊柱科常規(guī)路徑治療。隨訪12個月期間脫落4例,剔除3例(A組3例、B組4例),最終完成研究隨訪的65例患者(試驗A組33例、試驗B組32例)。治療前、治療后1天、1個月、6個月及12個月比較兩組血清中白介素6(IL-6)濃度,治療前、治療后1天、1個月、3個月、6個月及12個月比較兩組患者VAS評分、J0A評分及術后12個月Macnab優(yōu)良率,客觀評價兩種治療方案,從而找到更加快速、有效治療方案。結果:兩組患者一般資料(性別、年齡、年齡分布區(qū)間、病程及責任階段等)比較差異,均無統(tǒng)計學意義(P0.05),基本一致。術后第1天疼痛VAS評分及下腰痛J0A評分、血清中IL-6濃度經(jīng)椎間孔神經(jīng)根阻滯術組改善顯著,虛痹方組未見明顯改善;術后1個月、術后3個月兩組患者疼痛VAS評分、下腰痛J0A評分及術后1個月血清中IL-6濃度比較有顯著性差異(P0.05),經(jīng)椎間孔神經(jīng)根阻滯術組治療效果優(yōu)于虛痹方組。術后6個月兩組患者疼痛VAS評分、下腰痛J0A評分及血清中IL-6濃度比較無顯著性差異(P0.05),兩組治療效果相同。術后12個月兩組患者疼痛VAS評分、下腰痛J0A評分及血清中IL-6濃度比較有顯著性差異(P0.05),經(jīng)椎間孔神經(jīng)根阻滯術組療效降低,癥狀及體征反復,虛痹方組治療效果優(yōu)于經(jīng)椎間孔神經(jīng)根阻滯術組。治療12個月后隨訪,虛痹方組總優(yōu)良率為90.63%,經(jīng)椎間孔神經(jīng)根阻滯術組總優(yōu)良率為66.67%。結論:本課題所選兩種治療方案均能有效改善虛痹型腰椎間盤突出癥患者癥狀及體征。從血清中IL-6濃度、疼痛VAS評分及下腰痛J0A評分指標變化可知:兩組前3個月短期療效,經(jīng)椎間孔選擇性神經(jīng)根阻滯術組優(yōu)于虛痹方組;6個月療效基本一致,12個月中長期療效,虛痹方組優(yōu)于經(jīng)椎間孔選擇性神經(jīng)根阻滯術組。以中西醫(yī)結合理論為基礎,把兩種治療方案有效結合,相得益彰,值得應用。
[Abstract]:Objective: selective nerve root block through intervertebral foramen (Transforaminal selective nerve root block) is a clinical experience prescription based on the theory of warming and nourishing du pulse. By observing the clinical symptoms, laboratory examination and other indexes, this paper objectively evaluates the clinical efficacy of the two treatment schemes, and provides the best treatment scheme for the clinical treatment of lumbar disc herniation. Methods: from February 2015 to February 2016, 72 patients in the Department of Spine Orthopaedics, the third affiliated Hospital of Guangzhou University of traditional Chinese Medicine, were included in the study. Patients were randomly divided into two groups on the basis of signing "informed consent to patient treatment Scheme". Group A was treated with routine spinal pathway through intervertebral foramen selective nerve root block. Experimental group B: Xiubi prescription (4 courses of treatment, 1 week of treatment) spinal routine path therapy. During the 12 months follow-up, 4 cases were dropped off, 3 cases were removed (3 cases in group A, 4 cases in group B), 65 patients (33 cases in group A and 32 cases in group B) were finally followed up. Before treatment, 1 day, 1 month, 6 months and 12 months after treatment, the serum levels of interleukin 6 (IL-6) were compared between the two groups. After 1 day, 1 month, 3 months, 6 months and 12 months after treatment, the VAS score of J0A and the excellent and good rate of Macnab at 12 months after treatment were compared between the two groups, and the two treatment schemes were evaluated objectively, so as to find a more rapid and effective treatment scheme. Results: there was no significant difference between the two groups in general data (sex, age distribution interval, course of disease and responsibility stage) (P0.05). On the first day after operation, the VAS score of pain and the J0A score of low back pain were significantly improved in the serum IL-6 concentration in the intervertebral foramen nerve root block group, but not in the deficiency bi prescription group, and the pain VAS score in the two groups was significantly improved at 1 month and 3 months after operation. There was significant difference in J0A score of lower back pain and serum IL-6 concentration 1 month after operation (P0.05). The effect of nerve root block through intervertebral foramen was better than that of Xibi Fang group. There was no significant difference in pain VAS score, lower back pain J0A score and serum IL-6 concentration between the two groups 6 months after operation (P0.05). There were significant differences in pain VAS score, lower back pain J0A score and serum IL-6 concentration between the two groups 12 months after operation (P0.05). The effect of deficiency-bi prescription group was better than that of intervertebral foramen nerve root block group. After 12 months follow-up, the total excellent and good rate of Xiubi prescription group was 90.63 and that of intervertebral foramen nerve root block group was 66.67. Conclusion: the two treatments can effectively improve the symptoms and signs of the patients with asthenia-arthralgia type lumbar disc herniation. From the changes of serum IL-6 concentration, VAS score of pain and J0A score of low back pain, we can see that the short-term curative effect of the two groups in the first 3 months, the selective nerve root block through intervertebral foramen group is better than that in the deficiency Bi prescription group, the curative effect is basically the same at 6 months, and the medium and long term curative effect at 12 months. The deficiency bi prescription group was superior to the selective nerve root block group through intervertebral foramen. Based on the theory of integration of traditional Chinese and western medicine, the two therapeutic schemes are effectively combined to complement each other and are worthy of application.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R274.9

【參考文獻】

相關期刊論文 前10條

1 姜昆;劉晴晴;陶寶琛;鄭斌;魏成建;;補益肝腎、活血化瘀類中藥復方治療腰椎間盤突出癥的Meta分析[J];中國藥房;2016年36期

2 趙芝婷;周建;;針灸治療腰椎間盤突出癥的療效觀察[J];陜西中醫(yī);2016年10期

3 陳義方;容永純;鄧國梁;;絕對臥床休息對非手術治療腰椎間盤突出癥療效的影響[J];中國實用醫(yī)藥;2016年24期

4 姜錚;;推拿治療腰椎間盤突出癥115例臨床報告[J];世界最新醫(yī)學信息文摘;2016年42期

5 宋明霞;沈友虎;胡長順;;溫針灸治療腰椎間盤突出癥臨床療效觀察[J];中國中醫(yī)急癥;2016年02期

6 韓岳;夏群;徐寶山;吉寧;馬信龍;;選擇性神經(jīng)根封閉術在微創(chuàng)治療不典型椎間盤突出癥中的定位應用價值[J];天津醫(yī)科大學學報;2016年01期

7 宋志剛;牛小育;;腰椎間盤突出癥患者血清指標與疼痛程度的關系研究[J];河北醫(yī)學;2015年12期

8 張立;漆松濤;王海;周強;李宏;石瑾;彭林;陸云濤;;胸腰骶段脊神經(jīng)根鞘結構的解剖學和組織學研究[J];中國臨床解剖學雜志;2015年05期

9 張霄瀟;李正勇;馬玉玲;馬雙成;;中藥枳實的研究進展[J];中國中藥雜志;2015年02期

10 王俊井;雷剛剛;;椎間盤源性腰痛的病理生理改變與診療技術的進展[J];南昌大學學報(醫(yī)學版);2013年10期

，

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