Kim Sang Beom, Lee Kyeong Woo, Lee Jong Hwa, Kim Min Ah, An Byoung Woo
Department of Physical Medicine and Rehabilitation, Dong-A University College of Medicine, Busan 602-715, Korea.
Ann Rehabil Med. 2012 Aug;36(4):466-73. doi: 10.5535/arm.2012.36.4.466. Epub 2012 Aug 27.
To evaluate the effect of hyaluronidase in patients with failed back surgery syndrome (FBSS) treated with interlaminar lumbar epidural injection (ILEI).
Sixty patients suffering from severe low back pain and sciatica were randomly allocated into three groups. Group T received ILEI with 2 ml triamcinolone 40 mg/ml and 5 ml bupivacaine 0.25%. Group H received ILEI with 1500 IU hyaluronidase and 5 ml bupivacaine 0.25%. Group TH received interlaminar lumbar epidural injection (ILEI) with 1500 IU hyaluronidase, 2 ml triamcinolone 40 mg/ml and 5 ml bupivacaine 0.25%. The effect was evaluated using Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) at pre-injection, 2 weeks, 6 weeks and 12 weeks after ILEI.
After 2 weeks and after 6 weeks, patients in both Group T and Group TH had significant effectiveness more than Group H in decrease of VAS and ODI. After 12 weeks, only patients in Group TH had significant effectiveness in decrease of VAS and ODI (p<0.05). In every period, Group TH had the most effectivess in decrease of VAS and ODI after ILEI.
ILEI for FBSS with triamcinolone and hyaluronidase is considered to have more long term effectiveness to reduce pain and improve function after ILEI than injection with triamcinolone alone or hyaluronidase alone.
评估透明质酸酶在经椎间孔腰椎硬膜外注射（ILEI）治疗腰椎手术失败综合征（FBSS）患者中的效果。
将60例患有严重腰痛和坐骨神经痛的患者随机分为三组。T组接受ILEI，注射2 ml 40 mg/ml曲安奈德和5 ml 0.25%布比卡因。H组接受ILEI，注射1500 IU透明质酸酶和5 ml 0.25%布比卡因。TH组接受ILEI，注射1500 IU透明质酸酶、2 ml 40 mg/ml曲安奈德和5 ml 0.25%布比卡因。在ILEI前、注射后2周、6周和12周使用视觉模拟评分法（VAS）和Oswestry功能障碍指数（ODI）评估效果。
在注射后2周和6周时，T组和TH组患者在VAS和ODI降低方面的有效性均显著高于H组。在12周后，只有TH组患者在VAS和ODI降低方面有显著效果（p<0.05）。在每个时间段，TH组在ILEI后降低VAS和ODI方面效果最为显著。
对于FBSS，与单独注射曲安奈德或透明质酸酶相比，ILEI联合曲安奈德和透明质酸酶在注射后减轻疼痛和改善功能方面具有更长期的效果。
