亚甲蓝治疗腰椎小关节综合征的临床效果及安全性研究

摘要:

目的：观察超声引导下腰椎关节突关节囊内注射亚甲蓝（methylene blue，MB）治疗腰椎小关节综合征（lumbar facet joint syndrome, LFJS）的临床效果及安全性。方法：120例LFJS患者随机均分为亚甲蓝组（MB组）和激素组（Control组）。评价患者治疗前后数字疼痛评分(Numeric Rating Scales)、腰椎Oswestry功能障碍指数 (Oswestry Disability Index,ODI) 、匹兹堡睡眠质量指数(Pittsburgh Sleep Quality Index ,PSQI)、焦虑抑郁程度（Patient Health Questionnaire-9,PHQ-9）及综合疗效，并记录不良事件。结果: MB组患者术后1周、1个月时NRS评分略低于Control组，3个月和6个月时显著比对照组低（P < 0.05）；术后6个月时ODI、PHQ-9、PSQI评分均明显下降（P < 0.05）；疗效评价6个月时MB组疗效优于对照组（P < 0.05）；术后第1天MB组患者中合并糖尿病者高血糖的发生率明显比对照组低（P < 0.05），其他不良反应（高血压、恶心、呕吐）无明显差异。结论：超声引导腰椎关节突关节囊内注射亚甲蓝能够显著减轻LFJS患者的疼痛，改善腰椎功能状态，缓解其焦虑抑郁情绪、睡眠质量，且不良反应少安全性高。

Abstract:

Objective: To observe the clinical efficacy and safety of ultrasound-guided intra-articular injection of methylene blue in the treatment of lumbar facet joint syndrome(LFJS). Methods: 120 patients with LFJS were randomly divided into methylene blue group (MB group) and steroids group (Control group). Numeric Rating Scales (NRS), Oswestry Disability Index (ODI), Pittsburgh Sleep Quality Index (PSQI), Patient Health Questionnaire-9(PHQ-9) were evaluated preoperation and after operation, and adverse events were recorded. Results: The NRS scores of the methylene blue group was slightly lower than that of the control group at 1 week and 1 month after operation, but it was significantly better than control group at 3 months and 6 months (P < 0.05). The ODI, PHQ-9, and PSQI scores of the MB group significantly decreased at 6 months (P < 0.05). As for clinical efficacy, the MB group was better than control group(P < 0.05). On the first day after operation, the incidence of hyperglycemia in patients with diabetes in the MB group was significantly lower than that of the control group(P < 0.05), and other adverse reactions (hypertension, nausea and vomiting) with no significant difference. Conclusion: Ultrasound-guided intra-articular injection of methylene blue can significantly relieve the symptoms of patients with LFJS, improve the function and enhance the quality of life, with less adverse reactions and more safety.