Sun Chang-le
Department of Orthopedics, People's Hospital of Fuyang, Anhui, China.
Zhongguo Gu Shang. 2011 Oct;24(10):828-30.
To investigate the application and clinical effects of spatula for the treatment of the 3rd lumbar vertebrae transverse process syndrome.
From December 2009 to October 2010, 38 patients with the 3rd lumbar vertebrae transverse process syndrome were treated by spatula, of them, 33 patients were follow-up. Among the patients,19 cases were male and 14 cases were female,with an average age of (37.6+/-7.8) years (ranged from 28 to 58 years). The course of this diseases ranged from 10 days to 14 months with an average of (126.9+/-14.7) days. The main symptoms of the patients including unilateral lumbar pain, lateral bend waist limitation,the ache became even worse after exertion or prolonged sitting and radiated to the affected side of thigh and popliteal fossa,but the pain never exceed knee joint. The tenderness at the tip of the 3rd lumbar vertebrae was obviously and the contract muscle bundle could be touched. The X-rays showed the two sides of the transverse were asymmetric. CT or MRI was used to exclude spinal stenosis,tumor,and intervertebral disk hernia. Spatula was applied for sow discord and solution accretion, and injected compound medicine (0.2% Lidocaine 3 ml, Triamcinolone acetonide 5 ml, add 0.9% physiological sailine 2 ml to 10 ml). If the symptoms did not improved after the first treatment, start the second treatment one week later, but it was not more than three times. According to the standard of JOA score, the effects before and after treatment were evaluated by low back pain, leg pain or numbness, gait, Straight Leg Raising test, sensory and movement disorder,bladder function test.
Thirty-three patients were followed up for 2-12 months with an average of 4 months. All of the incisions were healed without complications. The clinical symptoms were improved and 22 cases were treated once, 7 cases twice and 4 cases 3 times. According to JOA evaluation criteria,the score before and after treatment was increased from (7.03+/-3.81) to (13.29+/-3.78), and 26 cases got excellent result, 5 good, 2 fair.
3rd lumbar vertebrae transverse process syndrome is one of the indications of the spatula. If the diagnose is correct, lesions position precisely located and operation performed properly, the treatment by spatula showed confirmed therapeutic effects, low complication and high safety.
探讨小针刀治疗第三腰椎横突综合征的应用及临床疗效。
2009年12月至2010年10月，采用小针刀治疗38例第三腰椎横突综合征患者，其中33例进行随访。患者中，男19例，女14例，平均年龄（37.6±7.8）岁（28～58岁）。病程10天至14个月，平均（126.9±14.7）天。患者主要症状为单侧腰部疼痛，向患侧弯腰受限，劳累或久坐后疼痛加重，疼痛放射至患侧大腿及腘窝，但不超过膝关节。第三腰椎横突尖部压痛明显，可触及紧张的肌束。X线显示双侧横突不对称。采用CT或MRI排除椎管狭窄、肿瘤及椎间盘突出。用小针刀进行松解和剥离，注入复方药物（0.2%利多卡因3ml、曲安奈德5ml，加0.9%生理盐水2ml至10ml）。若首次治疗后症状未改善，1周后进行第二次治疗，但不超过3次。根据JOA评分标准，通过腰痛、腿痛或麻木、步态、直腿抬高试验、感觉和运动障碍、膀胱功能试验评估治疗前后的效果。
33例患者随访2～12个月，平均4个月。所有切口均愈合，无并发症。临床症状改善，22例治疗1次，7例治疗2次，4例治疗3次。根据JOA评估标准，治疗前后评分从（7.03±3.81）提高到（13.29±3.78），优26例，良5例，可2例。
第三腰椎横突综合征是小针刀的适应证之一。若诊断正确，病变定位准确，操作得当，小针刀治疗疗效确切，并发症少，安全性高。
