椎管狭窄程度对腰椎管狭窄症行保守治疗的影响分析
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摘要
目的探讨腰椎管狭窄症患者行综合保守治疗的疗效,以及椎管狭窄程度对其疗效的影响。方法自2013-05-2015-05,采用综合保守治疗127例腰椎管狭窄症患者,包括绝对卧床休息、针刺、前屈滚腰疗法与辩证中药内服等治疗措施,各项治疗时间均为2周。对患者治疗前、治疗1周、2周和随访1个月、6个月时的VAS评分、JOA评分进行对比,同时在随访6个月时依据JOA评分改善率进行疗效评价。依据疗效评价结果,对疗效与狭窄程度的相关性采用Kendall’s tau-b序相关分析。结果共121例完成6个月随访。(1)此121例患者在治疗后1周、2周结束时,以及随访1、6个月的VAS评分与JOA评分均较治疗前显著改善(P<0.05);末次随访时,显效16例,有效82例,无效23例,总有效率为80.99%。(2)121例中,一度狭窄15例,二度狭窄57例,三度狭窄49例。对狭窄程度与疗效之间进行Kendall’s tau-b序相关分析,并未见统计学意义(P>0.05)。结论腰椎管狭窄症行综合保守治疗可有效改善临床症状、提高日常生活能力,其狭窄程度与疗效之间并无明确相关性,即无论狭窄程度轻重,均应以保守治疗作为首选方案。
Objective To investigate the effect of comprehensive conservative treatment on lumbar spinal stenosis,and the influence of the degree of spinal stenosis on the curative effect.MethodsFrom May 2013 to May 2015,127 patients with lumbar spinal stenosis were treated by conservative treatment,including absolute bed rest,acupuncture,lumbar flexion rolling therapy and traditional Chinese medicine dialectical therapy,the treatment time was 2 weeks.The VAS score and JOA score were compared before treatment,1 week,2 weeks,1 month and 6 months after treatment,and the curative effect was evaluated according to the improvement rate of JOA score at the follow-up of 6 months.According to the curative effect evaluation results,the correlation between the curative effect and the degree of stenosis was analyzed by Kendall's tau-b order correlation analysis.Results A total of 121 patients were followed up for 6 months.(1)The 121 patients were followed up for 1week,2 weeks,1 month and 6 months after treatment,the VAS score and JOA score were significantly improved(P<0.05).At the last follow-up,16 cases were markedly effective,82 cases were effective,23cases were ineffective,and the total effective rate was 80.99%.(2)Among 121 cases,15 cases were stenosis in grade I,57 cases were stenosis in grade II,49 cases were stenosis in grade III.There was no statistically significant correlation between the degree of stenosis and the efficacy of Kendall's taub sequence analysis(P>0.05).Conclusion Lumbar spinal stenosis underwent conservative treatment can effectively improve the clinical symptoms,improve the ability of daily life,there is no clear correlation between the degree of stenosis and the curative effect,regardless of the degree of stenosis severity should be based on conservative treatment as the preferred solution.
Objective To investigate the effect of comprehensive conservative treatment on lumbar spinal stenosis,and the influence of the degree of spinal stenosis on the curative effect.MethodsFrom May 2013 to May 2015,127 patients with lumbar spinal stenosis were treated by conservative treatment,including absolute bed rest,acupuncture,lumbar flexion rolling therapy and traditional Chinese medicine dialectical therapy,the treatment time was 2 weeks.The VAS score and JOA score were compared before treatment,1 week,2 weeks,1 month and 6 months after treatment,and the curative effect was evaluated according to the improvement rate of JOA score at the follow-up of 6 months.According to the curative effect evaluation results,the correlation between the curative effect and the degree of stenosis was analyzed by Kendall's tau-b order correlation analysis.Results A total of 121 patients were followed up for 6 months.(1)The 121 patients were followed up for 1week,2 weeks,1 month and 6 months after treatment,the VAS score and JOA score were significantly improved(P<0.05).At the last follow-up,16 cases were markedly effective,82 cases were effective,23cases were ineffective,and the total effective rate was 80.99%.(2)Among 121 cases,15 cases were stenosis in grade I,57 cases were stenosis in grade II,49 cases were stenosis in grade III.There was no statistically significant correlation between the degree of stenosis and the efficacy of Kendall's taub sequence analysis(P>0.05).Conclusion Lumbar spinal stenosis underwent conservative treatment can effectively improve the clinical symptoms,improve the ability of daily life,there is no clear correlation between the degree of stenosis and the curative effect,regardless of the degree of stenosis severity should be based on conservative treatment as the preferred solution.
引文
[1]Kao FC,T aai TT,Chen LH,et al. Symptomatic epidural hematomaafter lumbar decompression surgery[J]. Eur Spine J,2015,24(2):284-357.
[2]Pain B,Telfeian AE. A retrospective evaluation of the clinicalsuccess of transforaminal endoscopic discectomy with foraminotomyin geriatric patients[J]. Pain physician,2013,16(3):225-229.
[3]侯宇.前屈滚腰法治疗DLSS的临床研究及有限元分析[D].广州中医药大学,2014.
[4]Ivanov I, Milenkovic Z, Stefanovic I, et al. Lumbar spinal stenosis.Symptomatology and methods of treatment[J]. Srp Arh Celok Lek,1998,126(11-12):450-456.
[5]徐运瑜.针灸并用治疗腰椎管狭窄症的临床观察[J].浙江中医杂志,2014,49(5):362-363.
[6]梁以豪.林氏前屈滚腰法治疗轻中度腰椎管狭窄症的临床研究[D].广州中医药大学,2016.
[7]侯宇.前屈滚腰法治疗DLSS的临床研究及有限元分析[D].广州中医药大学,2014.
[8]袁仕国.退行性腰椎管狭窄和侧凸的影像表现及临床相关性[D].南方医科大学,2016.
[2]Pain B,Telfeian AE. A retrospective evaluation of the clinicalsuccess of transforaminal endoscopic discectomy with foraminotomyin geriatric patients[J]. Pain physician,2013,16(3):225-229.
[3]侯宇.前屈滚腰法治疗DLSS的临床研究及有限元分析[D].广州中医药大学,2014.
[4]Ivanov I, Milenkovic Z, Stefanovic I, et al. Lumbar spinal stenosis.Symptomatology and methods of treatment[J]. Srp Arh Celok Lek,1998,126(11-12):450-456.
[5]徐运瑜.针灸并用治疗腰椎管狭窄症的临床观察[J].浙江中医杂志,2014,49(5):362-363.
[6]梁以豪.林氏前屈滚腰法治疗轻中度腰椎管狭窄症的临床研究[D].广州中医药大学,2016.
[7]侯宇.前屈滚腰法治疗DLSS的临床研究及有限元分析[D].广州中医药大学,2014.
[8]袁仕国.退行性腰椎管狭窄和侧凸的影像表现及临床相关性[D].南方医科大学,2016.