小针刀合营部分阻滞治疗臀上皮神经卡压症.doc

小针刀配合局部阻滞治疗臀上皮神经卡压症  周广明 陈丽霞广西玉林市第一人民医院疼痛科 ?  【摘要】目的 观察小针刀疗法配合局部药物阻滞治疗臀上皮神经卡压症的临床疗效。方法 对52例臀上皮神经卡压症患者采用小针刀疗法配合局部注射2%利多卡因3ml、维生素B12 500μg、曲安奈德20mg及红花注射液5 ml混合液。结果 痊愈39例,好转13例,总有效率100%，经3月～1年随访,痊愈47例，好转5例。结论 小针刀疗法配合局部药物阻滞治疗臀上皮神经卡压症有可靠的疗效。【关键词】神经卡压综合征????小刀针????注射????神经传导阻滞????Acupotomy combined with local nerve block for treating superior gluteal nerve entrapment ZHOU Guang-ming CHEN Li-xia Department of Pain Medicine;The Ist Peoples Hospital of Yulin;Yulin 537000;China 　Objective To investigate the efficacy of acupotomy combined with local nerve block for treating superior gluteal nerve entrapment.Methods 52 patients of superior gluteal nerve entrapment were treated with acupotomy,combined with local nerve block with mixture solution(2% lidocaine 3 ml+ vitamin B12 500μg + triamcinolone 20 mg+ safflower injection 5 ml).Results 39 patients were cured,13 patients were effective,the total effective rate being 100%.With three months to one years follow-up,47 patients were cured,5 patients were effective.Conclusion Acupatomy combined with local nerve block for treating superior gluteal nerve entrapment has good therapeutic effect.???? 【Keyword】：Nerve Compression Syndrome;Small Knife Needle;Injections;Nerve Block ????臀上皮神经卡压症是腰腿痛的常见原因之一，以腰臀股痛，臀部可触及痛性条索状物为特征。多采用按摩、针灸、局部阻滞治疗，疗程长，效果欠佳，易复发, 部分患者尚需手术治疗[1]。自1997年以来我院门诊共采用小针刀配合局部阻滞治疗臀上皮神经卡压症患者52例, 现报告如下。????治疗方法????患者俯卧位, 在髂嵴的能棘肌外缘压痛明显处行痛点阻滞, 以2%利多卡因(lidocaine)3ml、维生素 B12(vitamin B12)500μg、曲安奈德(triamcinolone)20mg 及红花注射液(safflower injection)5ml混合共10ml。常规消毒后, 于痛点处进针直达深筋膜, 注药3ml后继续进针使针尖达骨面深部, 缓慢注药3ml，再将针稍退, 向四周肌肉作扇形浸润注射。出针后用汉章I型4号小针刀沿神经纤维走向垂直皮肤刺人, 酸胀感较重或有向下放射感时, 纵行切开数刀, 横行摆动分离两次出针。若臀部皮下有条索状物, 针体垂直皮肤刺人条索物, 酸胀明显时切开数刀, 纵行疏通剥离。然后, 将针身大幅度摆动数次, 手感松动后出针, 压迫针孔片刻, 用创可贴覆盖针孔。少数未愈者, 7日后再治疗1次, 最多不超过3次。????疗效评定标准 痊愈为治疗后1周, 腰腿疼痛消失, 腰腿部活动功能无受限, 1年内无复发。好转为腰腿疼痛较治疗前明显改善, 腰腿部活动功能轻度受限, 基本不影响日常生活, 1年内无复发。无效为治疗后腰腿疼痛与术前相比无明显差异, 腰腿部活动功能仍明显受限。 ????临床资料???一般资料 本组共52例，男20例，女32例，双侧6例，单侧46例，其中右侧35例，左侧11例；年龄22岁～岁，平均年龄42岁；病程4周～6.5年。????症状和体征分析