PRP联合类固醇激素/局麻药序贯注射疗法治疗胸腰椎小关节综合征的疗效观察

CURATIVE EFFECT OBSERVATION FOR THE TREATMENT OF THORACOLUMBAR FACET JOINT SYNDROME USING SEQUENTIAL INJECTION THERAPY COMBINED PRP WITH CORTICOSTEROID/LA

摘要:

目的：观察富血小板血浆(PRP)联合类固醇激素/局麻药的序贯注射疗法治疗胸腰椎小关节综合征的临床疗效。方法：61例胸腰椎小关节综合征患者随机分为对照组、类固醇激素/局麻药注射组、PRP注射组、联合序贯注射组，对照组予以口服非甾体类抗炎止痛药治疗，剩余3组在X线引导下行小关节腔内精准介入注射或小关节周围浸润注射治疗，评价治疗前、后的视觉模拟评分(VAS)、Oswestry 功能障碍指数(ODI)、Roland-Morris功能障碍调查表(RMQ)、改良MacNab评分及相关并发症发生情况。结果：腰背部疼痛VAS评分和腰椎功能评分结果均显示，对照组无明显治疗效果，类固醇激素/局麻药注射组在中早期疗效更佳，PRP注射组在中后期疗效更佳，联合序贯注射组在治疗全程均有良好疗效。治疗后6个月的改良MacNab结果显示，PRP治疗组(73.33%)和联合序贯注射组(75.00%)优良率远高于对照组(20.00%)和类固醇激素/局麻药注射组(53.33%)。4组患者治疗过程中均无明显并发症发生。结论：PRP联合类固醇激素/局麻药序贯注射疗法在胸腰椎小关节综合征的治疗全程均有良好疗效，是一种更加值得推广的临床治疗技术。

Abstract:

Objective: To observe the clinical efficacy of the treatment of thoracolumbar facet joint syndrome using the sequential injection therapy combined platelet-rich plasma(PRP) with corticosteroid/local anesthetic(LA). Methods: 61 patients with thoracolumbar facet joint syndrome were randomly divided into control group, corticosteroid/LA injection group, PRP injection group, combined sequential injection group. Patients in the control group were administered with oral NSAIDs, patients in the other three groups were administered with intra-articular accurate injection or infiltrated injection around the facet joint under X-ray guidance. The visual analogue scale(VAS), Oswestry Disability Index(ODI), Roland-Morris Disability Questionnaire(RMQ), modified MacNab criteria and related complications before and after the treatment were evaluated. Results: The results of back pain VAS and lumbar functional capacity were showed control group without obvious efficacy, corticosteroid/LA injection group with better efficacy in the middle and?preliminary stage, PRP injection group with better efficacy in the middle and?late stage, combined sequential injection group with great efficacy in the whole stage. The results of modified MacNab criteria at 6 months after treatment were showed that the?excellent and good rates in the PRP injection group(73.33%) and combined sequential injection group(75.00%) were far better than that in the control group(20.00%) and corticosteroid/LA injection group(53.33%). There were no severe complications in four groups during treatment. Conclusion：The sequential injection therapy combined PRP with corticosteroid/LA for the treatment of thoracolumbar facet joint syndrome is more recommendable clinical technology with perfect efficacy in the whole therapeutic stage.