Objective: To compare the clinical efficacy and safety among three different entry points of needle knife, including tenderness point, intervertebral foramen point and articular process node, for lumbar disc herniation (LDH).
Methods: A total of 105 patients with LDH were randomly divided into a tenderness point group (35 cases, 1 case dropped off ), an intervertebral foramen point group (35 cases) and an articular process node group (35 cases, 1 case dropped off ). In the three groups, the needle knife was given at positive tenderness points of lumbosacral and hip, the external point of intervertebral foramen and the node of vertebral joint process respectively, once a week for a total of 4 times. The scores of Japanese Orthopaedic Association (JOA), Oswestry disability index (ODI), visual analogue scale (VAS) were recorded before treatment, 2 weeks and 4 weeks into treatment, and 3 months follow-up after treatment, and the clinical efficacy and safety was observed.
Results: Compared before treatment, the JOA scores in each group were increased 2, 4 weeks into treatment and in the follow-up (P<0.05); 4 weeks into treatment and in the follow-up, the JOA scores in the tenderness point group and the articular process node group were higher than those in the intervertebral foramen point group (P<0.05). Compared before treatment, except for ODI score 2 weeks into treatment in the intervertebral foramen point group, the ODI and VAS scores in each group were decreased 2, 4 weeks into treatment and in the follow-up (P<0.05), and the ODI scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05). In 2 weeks into treatment, the VAS scores in the tenderness point group and the articular process node group were lower than those in the intervertebral foramen point group (P<0.05); in 4 weeks into treatment and follow-up, the VAS scores in the tenderness point group were lower than the other two groups (P<0.05). After treatment, the clinical efficacy of each group was similar (P>0.05); during the follow-up, the total effective rate in the tenderness point group was higher than that in the intervertebral foramen point group (P<0.05). There were no serious adverse events in each group.
Conclusion: The three different entry points of needle knife all could improve the symptoms of patients with LDH. The comprehensive effect of improving the subjective symptoms, lumbar function, pain degree and long-term curative effect is better in the tenderness point group.
目的：比较压痛点、椎间孔点、关节突关节点3种不同针刀进针点治疗腰椎间盘突出症（LDH）的临床疗效及安全性。方法：将105例LDH患者随机分为压痛点组（35例，脱落1例）、椎间孔点组（35例）、关节突关节点组（35例，脱落1例）。3组分别取腰骶部及臀部阳性反应点、椎间孔外口点、椎体关节突关节点进行针刀治疗，每周1次，共治疗4次。观察各组治疗前，治疗2、4周后及治疗后3个月随访时日本骨科协会评估治疗分数（JOA）、腰椎Oswestry功能障碍指数（ODI）评分及视觉模拟量表（VAS）评分，并观察疗效及安全性。结果：治疗2、4周后及随访时，各组患者JOA评分均较治疗前升高（P<0.05）；治疗4周后及随访时，压痛点组、关节突关节点组患者JOA评分高于椎间孔点组（P<0.05）。治疗2、4周后及随访时，除椎间孔点组治疗2周后ODI评分外，各组患者ODI、VAS评分均较治疗前降低（P<0.05），压痛点组、关节突关节点组患者ODI评分低于椎间孔点组（P<0.05）；治疗2周后，压痛点组、关节突关节点组患者VAS评分低于椎间孔点组（P<0.05）；治疗4周后及随访时，压痛点组患者VAS评分低于其余两组（P<0.05）。治疗后，各组临床疗效相当（P>0.05）；随访时，压痛点组总有效率高于椎间孔点组（P<0.05）。各组均未出现严重不良反应。结论：3种不同针刀进针点均能改善LDH患者症状，在改善患者主观症状、腰椎功能、疼痛程度、远期疗效方面，压痛点综合效果更优。.
Keywords: articular process node; intervertebral foramen; lumbar disc herniation (LDH); needle knife; tenderness point.