Efficacy of ultrasound-guided arc-edge needle-knife therapy in the treatment of arthrogenic pain of lumbar facet joint pain of lumbar facet joint after foraminoscopy
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摘要:目的
观察超声引导下弧刃针刀松解责任腰椎上下关节突周围组织并注射镇痛液治疗椎板间入路椎间孔镜术后腰椎关节突关节源性疼痛的临床疗效以及安全性。
方法选取72例经椎板间入路椎间孔镜术后出现腰椎关节突关节源性疼痛的患者为研究对象，按照随机数字表法分为弧刃针组(n=36)与封闭针组(n=36)。弧刃针组采用超声引导下弧刃针刀松解责任腰椎上下关节突周围组织并注射镇痛液; 封闭针组参照腰椎AP位X线片的体表投影进行定位，责任腰椎上下关节突周围徒手行局部封闭针治疗。分别记录治疗前、治疗后1 d、1个月及3个月后的视觉模拟评分法(VAS)评分和Oswestry功能障碍指数(ODI)评分，通过日本骨科学会(JOA)评分计算治疗总有效率。
结果弧刃针组穿刺时间短于封闭针组，穿刺调整次数少于封闭针组，差异有统计学意义(P < 0.01)。2组治疗后1个月、3个月的VAS评分、ODI评分均优于治疗前及治疗后1 d，差异有统计学意义(P < 0.05)。弧刃针组治疗后1个月和3个月的VAS评分、ODI评分优于封闭针组，差异有统计学意义(P < 0.05)。弧刃针组治疗总有效率高于封闭针组，差异有统计学意义(P < 0.05)。
结论超声引导下弧刃针刀松解腰椎上下关节突周围组织并注射镇痛液缓解椎板间入路椎间孔镜术后腰椎关节源性疼痛的效果明显，具有持续性减轻疼痛的作用，在改善患者腰部功能有积极意义。
Abstract:ObjectiveTo observe the clinical efficacy and safety of ultrasound-guided arc-edge needle-knife therapy for treatment of lumbar arthrogenic pain of lumbar facet joint after foraminoscopy by releasing the tissue around the responsible upper and lower lumbar articular processes and injecting analgesic solution.
MethodsA total of 72 patients who presented with arthrogenic pain of the umbar facet joint after translaminar approach foraminoscopy were selected and divided into arc-edge needle group (n=36) and local anesthesia group (n=36)according to the random number table method. The arc-edge needle group was given ultrasound-guided arc-edge needle-knife therapy to release the tissues around the upper and lower articular processes of the responsible lumbar spine and injected analgesic solution. The local anesthesia group was performed freehand local closed-needle treatment around the upper and lower articular processes of the responsible lumbar spine in the location according to the body surface projection of AP radiographs of the lumbar spine. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were recorded before treatment, 1 day, 1 month and 3 months after treatment, respectively, and the total effective rate was calculated by the Japanese Orthopaedic Society (JOA) score.
ResultsThe puncture time and puncture adjustment times of the arc-edge needle group were shorter or less than those of the local anesthesia group, and the differences were statistically significant(P < 0.01). VAS scores and ODI scores of 1 month and 3 months after treatment were better than those before treatment and 1 day after treatment, and the differences were statistically significant (P < 0.05). The VAS scores and ODI scores of 1 month and 3 months after treatment in the arc-edge needle group were higher than those in the local anesthesia group, and the differences were statistically significant (P < 0.05). The total effective rate of the arc-edge needle group was higher than that of the local anesthesia group, and the difference was statistically significant (P < 0.05).
ConclusionRelease of periarticular tissues around the upper and lower lumbar synapses by ultrasound-guided arc-edge needle-knife therapy and injection of analgesic solution is effective in continuously relieving lumbar arthrogenic pain after foraminoscopy by releasing the tissue around the responsible upper and lower lumbar articular processes, and has positive significance in improving patients' lumbar function.
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表 1 2组一般资料比较(x±s)[n(%)]
组别 性别 年龄/岁 病程/d 责任椎间隙 男 女 L4/5 L5/S1 弧刃针组(n=36) 15(41.67) 21(58.33) 45.44±11.45 34.42±15.05 16(44.44) 20(55.56) 封闭针组(n=36) 17(47.22) 19(52.78) 45.11±10.25 34.31±11.60 19(52.78) 17(47.22) 
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表 2 2组穿刺效果比较(x±s)
组别 定位穿刺时间/min 穿刺调整次数/次 左 右 左 右 弧刃针组(n=36) 3.42±1.34** 3.33±1.15** 1.28±0.51** 1.36±0.64** 封闭针组(n=36) 8.19±2.21 8.22±2.11 2.19±0.92 2.11±0.78 与封闭针组比较, **P < 0.01。
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表 3 2组治疗前后VAS评分、ODI评分比较(x±s)
分 评分 组别 n 治疗前 治疗后1 d 治疗后1个月 治疗后3个月 VAS评分 弧刃针组 36 5.78±0.90 2.58±0.69 2.06±0.67*#△ 1.89±0.67*#△ 封闭针组 36 5.75±0.84 2.67±0.59 2.89±0.71*△ 2.67±0.68*△ ODI评分 弧刃针组 36 35.11±4.23 23.11±2.85 17.56±4.14*#△ 13.78±5.59*#△ 封闭针组 36 35.17±4.31 23.50±2.96 20.89±3.67*△ 17.89±6.21*△ 与治疗前比较, *P < 0.05; 与封闭针组比较, #P < 0.05; 与治疗后1 d比较, △P < 0.05。
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表 4 2组治疗总有效率比较[n(%)]
组别 临床控制 显效 有效 无效 总有效 弧刃针组(n=36) 1(2.78) 19(52.78) 13(36.11) 3(8.33) 33(91.67)* 封闭针组(n=36) 0 10(27.78) 18(50.00) 8(22.22) 28(77.78) 与封闭针组比较, *P<0.05。
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