CAJ | 학술논문

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。
배경：CT인도하경피개입화전통특색강복기술개위요추간반돌출증림상진료적경전방안，이자적유합시부유조우환자공능회복，취득교호적림상간예결국？ 　　목적：평고 CT 인도하경피약물개입결합강복일체화치료요추간반돌출증적림상료효，탐토영향료효적상관인소。 　　방법：우2010년5월지2013년5월，대88례요추간반돌출증환자행CT인도하경피약물개입결합강복일체화치료。약물유복방배타미송、단삼동ⅡA 광산납、신경타악평、생리염수화전해순등조성，강복종합치료포괄견인、추나、침구、경피신경전자격화자진열요법。료효평개채용Macnab표준화한화Oswestry공능장애지수(ODI)。병여선전보도적112례단순CT인도약물개입치료적림상료효진행통계학비교。채용관련분석탐토년령분조、병정분기、추간반돌출절단분형등대료효결국적영향。 　　결과여결론：1년수방77례환자，기중우64례，량7례，가5례，차1례，결국우량솔점92%。술후1개월、6개월화1년수방여치료전비교，환자개량Oswestry공능장애지수각조목급총분유축점강저적추세，차이유현저성의의(P<0.01)。납입환자미견엄중병발증발생。약물개입결합강복조여단순약물개입조상비결국우량솔유제고적추세，단차이상무현저성의의(P>0.05)。여>45세조비교，환자년령≤45세가취득교호적림상료효，조간비교차이유현저성의의(P<0.01)。병정장단、추간반돌출적형태、단절단화다절단돌출여료효결국상무명학적관련성(P>0.05)。결과표명CT인도하경피약물개입결합강복일체화치료가유효완해요추간반돌출증환자요배통급하지방사통증상，강저생활공능장애정도。
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 preferential y 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:Total y 77 patients were completely fol owed 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 fol ow-ups (P<0.01). No severe complications occurred in al 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 statistical y 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.