基于软外理论体外冲击波治疗脊柱源性腹痛的疗效观察

EFFICACY OF RADIAL EXTRACORPOREAL SHOCKWAVE THERAPY GUIDED BY THEORY OF SOFT TISSUE SURGERY FOR TREATMENT OF ABDOMINAL PAIN OF SPINAL ORIGIN

摘要:

目的：观察根据软组织外科学理论实施发散式体外冲击波疗法(radial extracorporeal shockwave therapy, rESWT)治疗脊柱源性腹痛(abdominal pain of spinal origin, APSO)的有效性及安全性。方法：23例APSO患者,在患侧下段胸椎(T6-12)和腰椎的棘突旁、椎板、关节突关节、横突,骶骨背面,髂嵴缘,肋弓下缘及耻骨联合上缘的敏感压痛点进行rESWT,每7d治疗1次,共治疗4次,比较病人每次治疗前、4次治疗结束后4w、12w及24w的疼痛数字评分(numerical rating scale,NRS)并作疗效评价。结果：治疗结束后4w、12w、24w的NRS较首次治疗前明显降低,差异具有显著意义(P<0.01)。在首次治疗前至治疗结束后12w相邻时间点中,后一个时间点NRS均较前一个时间点降低,差异具有显著意义(P<0.05)。患者治疗结束后4w、12w的显效率均为87.0%,治疗结束后24w的显效率为91.3%。未见与治疗相关不良反应发生。结论：依据软组织外科学理论实施体外冲击波治疗APSO安全、有效,值得临床推广应用。

Abstract:

Objective: To observe the efficacy and safety of radial extracorporeal shockwave therapy (rESWT) followed theory of soft tissue surgery in the treatment of abdominal pain of spinal origin. Methods: A prospective study was performed in patients with APSO (n=23) treated with rESWT in our hospital. The treatment of rESWT was applied to the specific tenderness points involving the Lower thoracic segment (T6-12) and the lumbar spinal segment including spinous process, vertebral lamina, facet joints, transverse processes, the back of the sacrum, the upper margin of iliac ridge, the lower costal margin and the superior margin of symphysis pubis of affected side. All patients were followed up with numerical rating scale (NRS) before each treatment and at 4, 12 and 24 week follow-ups after rESWT to evaluate the efficacy. Results: The scores of NRS at 4, 12 and 24 weeks after 4 times of rESWT were significantly improved compared with the preoperative baseline(P < 0.01). From the first treatment to 12 weeks follow-up, the score of NRS at the next time point was significantly lower than that at the in turn previous time point (P<0.05). The obvious effective rates(pain relief exceeding 50%) at 4 and 12 weeks follow-up were up to 87.0%, and that at 24-week follow-up was up to 91.3%. No serious adverse events were observed in the course of treatment. Conclusion: The rESWT for APSO under the guidance of the theory of soft tissue surgery is safe, effective and worthy of clinical application.