腰痛的治疗

M.-M. Lefèvre-Colau , Antoine Babinet (Praticien hospitalier, chirurgien des Hôpitaux) , Serge Poiraudeau (Professeur)
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引用次数: 8

摘要

95%的坐骨神经痛在没有对椎间盘突出进行药物治疗的情况下逐渐恢复,这一事实代表了治疗策略的主要论点。重复扫描和磁共振成像的可能性表明,椎间盘突出可能会在几个月后消失,无论其大小;然而,许多恢复发生在椎间盘突出仍然存在的时候。压缩引起的神经根变形并不是引起疼痛的唯一机制因素。此外,约20%的无症状患者可发现椎间盘突出的证据。对椎间盘性腰坐骨神经痛行手术治疗的患者进行长期随访,1年时行手术治疗的患者的临床病程与仅对症治疗的患者的临床病程无显著差异。因此,治疗普通坐骨神经痛不应只关注椎间盘压迫冲突。除手术紧急情况外,如马尾综合征伴生殖器-括约肌疾病和神经根性痛伴加重运动障碍,所有可用的治疗椎间盘突出症的药物应至少试用2-3个月,然后再决定局部治疗。从未有证据表明,坐骨神经痛的恢复可能受到神经根疼痛持续时间的危害
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Traitement des lomboradiculalgies

The fact that 95% of sciaticas evolve towards recovery without medical treatment of the herniated disk represents a major argument of the therapeutic strategy. The possibility of repeating scanography and magnetic resonance imaging allowed to show that a herniated disk may disappear after some months whatever its size; however many recoveries occur while the herniated disk is still present. The compression-induced radicular deformation is not the only mechanism factor of pain. In addition, an evidence of herniated disk may be found in about 20% of asymptomatic subjects. Long-term follow-up of patients with a discal lumbagosciatica in which surgery was indicated, shows at 1 year that the clinical course of patients who underwent surgery doesn’t differ significantly from that of patients who only received a symptomatic medical treatment. Thus, treatment of common sciatica should not exclusively focus on the diskoradicular compression conflict. Except in cases of surgical emergencies such as a cauda equina syndrome with genital-sphincter disorders, and radiculalgias with aggravating motor impairment, all available medical treatments for the herniated disk should be tried for at least 2-3 months before making decision for local treatment. It has never been evidenced that potential sciatica recovery could be jeopardized by the duration of radicular pain

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