[腰椎间盘突出症引起的坐骨神经痛的保守综合疗法:机械理疗(McKenzie)、加巴喷丁和经椎间孔硬膜外注射]。

IF 1.1 4区 医学 Q3 ANESTHESIOLOGY
Schmerz Pub Date : 2024-08-12 DOI:10.1007/s00482-024-00824-y
Manuela Jäntsch-Rieckert, Oliver Rommel, Verena Kästner, Lotte Maercklin-Rommel, Georg Jäger
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引用次数: 0

摘要

背景:腰椎间盘突出症引起的坐骨神经痛的治疗方法有手术和保守两种。据描述,保守治疗对 90% 的患者有效;然而,大多数研究并未采用一致的治疗理念:在本研究中,我们评估了 40 名患者在为期 10 天的住院治疗期间接受非手术综合治疗(麦肯茨理疗、加巴喷丁和椎间盘周围注射)的效果:除神经骨科检查外,还对休息时和行走后的疼痛严重程度进行了评估。对奥斯韦特里疼痛残疾量表、疼痛严重程度量表和疼痛DETECT量表进行了检查,以评估神经性疼痛成分。此外,还记录了丧失工作能力的持续时间以及是否需要进行后期手术。检查时间为入院当天、第3天、第6天、第10天和第84天,以及出院后3个月:在保守治疗期间,疼痛持续减轻,直腿抬高试验和手指到地面的距离都有所改善。由于三种治疗方案都有时间延迟,因此可以证明所有治疗方案都对疼痛的改善有显著作用。所有治疗方法均可耐受,无副作用,且在 12 周后仍有改善。入院时,32%的患者表现出神经性疼痛,随访时这一比例降至 7%。共有 28 名患者在入院时出现肌力减退,随访时减至 7 人。70%的患者在肌电图检查中发现了病理结果。患者的生活质量(Oswestry 失能指数[ODI])明显改善,并在 5.8 周后重返工作岗位。只有 3/40 的患者因持续疼痛而需要手术治疗:结论:非手术综合治疗方案有效且耐受性良好。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

[Conservative combination therapy of sciatica due to lumbar disc herniation with mechanical physiotherapy (McKenzie), gabapentin, and transforaminal epidural injections].

[Conservative combination therapy of sciatica due to lumbar disc herniation with mechanical physiotherapy (McKenzie), gabapentin, and transforaminal epidural injections].

Background: Treatment of sciatica due to lumbar disc herniation can be surgical or conservative. Conservative management has been described to be effective in 90% of patients; however, in most studies no consistent treatment concept was used.

Objectives: In the present study, we evaluated the effect of a combined nonsurgical management (McKenzie physiotherapy, gabapentin, and periradicular injections) in 40 patients during a 10-day inpatient treatment.

Methods: In addition to the neuro-orthopedic examination, pain severity at rest and after walking were assessed. The Oswestry pain disability scale, the pain severity scale, and the painDETECT scale were examined to assess neuropathic pain components. The duration of incapacity for work and the requirement of a later surgery were recorded. Examinations were performed on the day of admission, on days 3, 6, 10, and 84, 3 months after discharge.

Results: During conservative treatment, a continuous reduction of pain and an improvement of the straight leg raise test as well as finger-to-floor distance could be documented. As the three treatment options were introduced with a time delay, it could be demonstrated that all significantly contributed to the improvement. All treatments were tolerated without side-effects and persistent improvement after 12 weeks. On admission, 32% of patients revealed a neuropathic pain component which decreased to 7% at the follow-up. A total of 28 patients showed impaired muscle strength on admission, which decreased to 7 patients on follow-up. Electromyography revealed pathological results in 70% of patients examined. A significant improvement of quality of life (Oswestry Disability Index [ODI]) could be observed and the patients returned to work after 5.8 weeks. Only 3/40 patients required surgical management due to persistent pain.

Conclusion: The combined nonsurgical operative treatment program is effective and well tolerated.

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来源期刊
Schmerz
Schmerz 医学-临床神经学
CiteScore
2.00
自引率
20.00%
发文量
64
审稿时长
6-12 weeks
期刊介绍: Der Schmerz is an internationally recognized journal and addresses all scientists, practitioners and psychologists, dealing with the treatment of pain patients or working in pain research. The aim of the journal is to enhance the treatment of pain patients in the long run. Review articles provide an overview on selected topics and offer the reader a summary of current findings from all fields of pain research, pain management and pain symptom management. Freely submitted original papers allow the presentation of important clinical studies and serve the scientific exchange. Case reports feature interesting cases and aim at optimizing diagnostic and therapeutic strategies. Review articles under the rubric ''Continuing Medical Education'' present verified results of scientific research and their integration into daily practice.
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