Objective: To observe the effect of acupotomy on the fat infiltration degree of lumbar multifidus muscle (LMM) in patients with lumbar disc herniation after percutaneous transforaminal endoscopic discectomy (PTED).
Methods: A total of 104 patients with lumbar disc herniation treated with PTED were randomly divided into an observation group (52 cases, 3 cases dropped off) and a control group (52 cases, 4 cases dropped off). Patients of both groups received rehabilitation training of two weeks 48 h after PTED treatment. The observation group was treated with acupotomy (L3-L5 Jiaji [EX-B 2]) once within 24 h after PTED. In the two groups, the fat infiltration cross sectional area (CSA) of LMM was compared before and 6 months after PTED, the visual analogue scale (VAS) score and Oswestry disability index (ODI) score were observed before and 1, 6 months after PTED. The correlation between fat infiltration CSA of LMM in each segment and VAS score was analyzed.
Results: Six months after PTED, the fat infiltration CSA of LMM in L4/L5 and the total L3-S1 segments of the observation group was lower than that before PTED (P<0.05), and the fat infiltration CSA of LMM in L4/L5 of the observation group was lower than the control group (P<0.01). One month after PTED, the ODI and VAS scores of the two groups were lower than those before PTED (P<0.01), and those in the observation group were lower than the control group (P<0.05). Six months after PTED, the ODI and VAS scores of the two groups were lower than those before PTED and 1 month after PTED (P<0.01), and those in the observation group were lower than the control group (P<0.01). There was a positive correlation between the fat infiltration CSA of LMM in the total L3-S1 segments and VAS scores in the two groups before PTED (r = 0.64, P<0.01). Six months after PTED, there was no correlation between the fat infiltration CSA of LMM in each segment and VAS scores in the two groups (P>0.05).
Conclusion: Acupotomy can improve the fat infiltration degree of LMM, pain symptoms and activities of daily living in patients with lumbar disc herniation after PTED.
目的：观察针刀对腰椎间盘突出症患者经皮椎间孔镜术（PTED）后腰段多裂肌（LMM）脂肪浸润程度的影响。方法：将104名接受PTED治疗的腰椎间盘突出症患者随机分为观察组（52例，脱落3例）和对照组（52例，脱落4例）。两组患者均于PTED治疗48 h后开始接受两周的康复训练，观察组患者术后24 h内进行1次针刀（L3~L5夹脊穴）治疗。比较两组患者术前、术后6个月LMM脂肪浸润横截面积（CSA），观察两组患者术前及术后1、6个月视觉模拟量表（VAS）评分和Oswestry功能障碍指数（ODI）评分，并对各节段LMM脂肪浸润CSA与VAS评分进行相关性分析。结果：术后6个月，观察组患者L4/L5及L3~S1总体节段LMM脂肪浸润CSA较术前降低（P<0.05），观察组患者L4/L5节段LMM脂肪浸润CSA低于对照组（P<0.01）。术后1个月，两组患者ODI、VAS评分均较术前降低（P<0.01），且观察组低于对照组（P<0.05）；术后6个月，两组患者ODI、VAS评分均较术前、术后1个月降低（P<0.01），且观察组低于对照组（P<0.01）。两组患者术前L3~S1总体节段LMM脂肪浸润CSA与VAS评分呈正相关（r =0.64，P<0.01）；术后6个月，两组患者各节段LMM脂肪浸润CSA与VAS评分均无相关性（P>0.05）。结论：针刀能够改善腰椎间盘突出症患者PTED后LMM脂肪浸润程度、疼痛症状和日常生活活动能力。.
Keywords: acupotomy; lumbar disc herniation; lumbar multifidus muscle; percutaneous transforaminal endoscopic discectomy.