目的：观察曲安奈德神经鞘内注射联合神经根周围用药治疗腰椎间盘突出症（ LDH）患者术后的疗效。方法选取2013年5—11月广西中医药大学第一附属医院骨一科收治的行传统髓核摘除术的LDH患者60例，采用随机数字表法，将其分为A组、B组、C组，各20例。在传统髓核摘除术中，A组在暴露的神经根鞘内用2 ml注射器注射曲安奈德注射液20 mg（半支），剩余20 mg曲安奈德注射液喷洒在神经根周围；B组于减压后在暴露的神经根周围喷洒曲安奈德注射液40 mg；C组减压后不做特殊处理。于术前，术后第1、3、7天及术后2周对患者进行疼痛视觉模拟量表（ VAS）评分、日本骨科协会（ JOA）评分、Oswestry功能障碍指数（ ODI）评分。结果3组患者性别、年龄、病程比较，差异均无统计学意义（P>0.05）；3组下床活动时间比较，差异有统计学意义（P<0.05），其中A组、B组下床活动时间均低于C组〔95%CI（0.09，0.71），P=0.011；95%CI（0.04，0.66），P=0.026〕。组间比较结果显示：A组、B组、C组术前VAS、JOA、ODI评分比较，差异无统计学意义（ F=0.225，P=0.799）。3组术后第1、3、7天及术后2周VAS、JOA、ODI评分比较，差异均有统计学意义（ F=58.54，P=0.000；F=84.98，P=0.000；F=10.01，P=0.019；F=8.15，P=0.038），其中术后第7天、术后2周A组VAS、JOA、ODI评分均低于B组和C组（P<0.05）。组内比较结果显示：3组术后第1、3、7天及术后2周VAS、JOA评分均低于术前，术后第3、7天及术后2周ODI评分均低于术前（P<0.05）。结论传统髓核摘除术在治疗LDH时，术中应用曲安奈德神经根干预，可缓解患者术后疼痛，尤其神经鞘内注射联合神经根周围喷洒曲安奈德更能取得满意疗效。%Objective To observe the clinical efficacy of intrathecal injection of triamcinolone acetonide combined with treatment around the nerve root on lumbar disc herniation( LDH) after operation. Methods 60 LDH patients who had tradition-al discectomy in first department of orthopedic,the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from May to November in 2013 were selected as study subjects,according to the random number table method,the patients were randomly divided into group A,group B and group C,with 20 cases in each group. During traditional discectomy,cases in group A received intrathecal injection of triamcinolone acetonide(20 mg) by using 2 ml syringe,and triamcinolone acetonide(20 mg) was sprayed around the nerve root;for cases in group B,triamcinolone acetonide(40 mg) was sprayed around the nerve root after decompression;for cases in group C,no special treatment was given after decompression. Before surgery,1,3,7 days and 2 weeks after surgery,patients were assessed using the visual analog pain scale( VAS),Japanese orthopaedic associa-tion(JOA)scoring system,and the Oswestry disability index(ODI). Results There was no significant difference in age, gender,course of disease among three groups(P>0. 05). There was significant difference in time to get out of bed after surgery among three groups(P<0. 05),time to get out of bed after surgery in group A and in group B was significantly shorter than that in group C,respectively〔95%CI(0. 09,0. 71),P=0. 011;95%CI(0. 04,0. 66),P=0. 026〕. According to compari-son results among groups,there was no significant difference in preoperative scores of VAS,JOA and ODI among three groups (F=0. 225,P=0. 799). There were significant differences in scores of VAS,JOA among three groups 1,3,7 days and 2 weeks after surgery(F=58. 54,P=0. 000;F=84. 98,P=0. 000;F=10. 01,P=0. 019;F=8. 15,P=0. 038). The scores of VAS,JOA and ODI in group A were significantly lower than those in group B and in group C(P<0. 05). According to results of intra-group comparison,the scores of VAS,JOA before surgery were significantly higher than those 1,3,7 days and 2 weeks after surgery for three groups and ODI was significantly higher than those 3,7 days and 2 weeks after surgery(P<0. 05). Conclusion During the traditional discectomy in the treatment of LDH,applying triamcinolone acetonide to nerve root can relieve postoperative pain,intrathecal injection of triamcinolone acetonide combined with treatment around the nerve root can achieve satisfactory effect.
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