Runu R, Sinha N K, Pai R, Shankar P R, Vijayabhaskar P
Department of Orthopaedics, Manipal College of Medical Sciences, Pokhara, Nepal.
Kathmandu Univ Med J (KUMJ). 2005 Oct-Dec;3(4):349-54.
Low back pain and sciatica is a common clinical condition. It is a most common orthopaedic complaint in the Kaski region of Nepal. The reason for its increased incidence may be hilly terrain, difficult working and living environment of the region. The initial treatment of Low back pain is conservative. Epidural steroid injection is being slowly established as are liable mode of conservative management in many orthopaedic centres of the world. This is a preliminary report of on-going study of the use of epidural steroid in the management of low back pain cases coming to the orthopaedic department of Manipal Teaching Hospital.
Prospective clinical trial was carried out on the patients reporting with low back pain and sciatica not responding to other modes of conservative treatment. Pre and post injection evaluation was done clinically. The level of pain, improvement in physical signs and ability to do activities of daily living were noted.
Fifty two patients were observed for the average duration of 2.87 months. Average duration of symptoms was for 10 months. After first epidural steroid injection 83% of patients reported relief on day one. In some cases the onset of analgesia was delayed. Four patients reported no relief after first injection. Fifteen patients were given two injections and four received three injections. The average duration between two injections was three weeks. Average duration of pain relief was 20 days. At the end of 3 months, good results were seen in 39%, fair in 33% and bad results in 27%. Overall 59% of patients were able to do activities of daily living. Three patients (5.76%)required operation for disc prolapse. Postoperatively two patients reported back with back pain. Most common complaint of patients after injection was pain at the injection site. No major complications were encountered.
Epidural Steroid Injection is a safe and effective mode of treatment of Low Back Pain. It provides painfree period to enable the patient for physiotherapy which helps in early recovery.
腰背痛和坐骨神经痛是常见的临床病症。在尼泊尔卡斯基地区，这是最常见的骨科病症。其发病率上升的原因可能是该地区多山的地形、艰苦的工作和生活环境。腰背痛的初始治疗是保守治疗。在世界许多骨科中心，硬膜外类固醇注射正逐渐成为一种可靠的保守治疗方式。这是一项正在进行的关于马尼帕尔教学医院骨科收治的腰背痛病例使用硬膜外类固醇治疗的初步报告。
对报告有腰背痛和坐骨神经痛且对其他保守治疗方式无反应的患者进行前瞻性临床试验。临床进行注射前后评估。记录疼痛程度、体征改善情况以及进行日常生活活动的能力。
观察了52例患者，平均观察时长为2.87个月。症状平均持续时间为10个月。首次硬膜外类固醇注射后，83%的患者在第一天报告疼痛缓解。在某些情况下，镇痛起效延迟。4例患者首次注射后无缓解。15例患者接受了两次注射，4例接受了三次注射。两次注射之间的平均间隔为三周。疼痛缓解的平均持续时间为20天。在3个月结束时，39%的患者效果良好，33%的患者效果尚可，27%的患者效果不佳。总体而言，59%的患者能够进行日常生活活动。3例患者（5.76%）因椎间盘突出需要手术。术后2例患者再次出现腰背痛。患者注射后最常见的主诉是注射部位疼痛。未遇到重大并发症。
硬膜外类固醇注射是治疗腰背痛的一种安全有效的方式。它提供无痛期，使患者能够进行物理治疗，这有助于早期康复。
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