| 压力痛阈测试在腰椎间盘突出症中的应用研究 |
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摘要点击次数: 2361
全文下载次数: 907
投稿时间：2019-03-20
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| 期刊信息：《中国骨伤》2020年，第33卷，第5期，第435-439页 |
| DOI：10.12200/j.issn.1003-0034.2020.05.009 |
| 基金项目:原空军后勤部司令部应用基础研究项目（编号：BKJ13J004）；首都临床特色应用研究与成果推广项目（编号：Z161100000516233） |
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中文摘要:
目的：通过压痛测量仪定量检测腰椎间盘突出症患者治疗前后腰椎后关节的压力痛觉阈值（pain pressure threshold，PPT），观察压力痛阈测试在腰椎间盘突出症中的临床应用价值。
方法：自2017年1月至2017年12月收治腰椎间盘突出症患者59例为患者组，社会上招募正常人59例为正常组。患者组入院时通过视觉模拟量表（visual analogue scale，VAS）测量患者的主观疼痛强度，通过压痛测量仪检测患者腰椎后关节痛阈大小，分别在压痛最明显的患侧后关节和对侧后关节连续测量3次，每次间隔1 min，均取平均值记为T值。所有患者在接受1个疗程的保守治疗后（冯氏脊柱定点旋转复位法+常规脱水消炎）再次测量VAS评分、两侧腰椎后关节痛阈指标。正常组随机选择一侧腰椎后关节进行压痛痛阈的测量。
结果：（1）两组受试者年龄、身高、体重、体重指数差异无统计学意义（P>0.05）。（2）压力痛阈测试具有较好的可重复性：依次对患侧后关节治疗前T值[（4.72±2.14）kg/cm2，（4.96±2.10）kg/cm2，（5.11±2.09）kg/cm2]，治疗后T值[（7.38±2.36）kg/cm2，（7.62±2.51）kg/cm2，（7.58±2.47）kg/cm2]，对侧后关节治疗前T值[（7.18±2.80）kg/cm2，（7.19±2.68）kg/cm2，（7.20±2.69）kg/cm2]，治疗后T值[（9.54±2.89）kg/cm2，（9.76±3.01）kg/cm2，（9.77±3.09）kg/cm2]和正常组随机后关节T值[（12.23±1.56）kg/cm2，（12.51±1.48）kg/cm2，（12.69±1.63）kg/cm2]共5组数据进行方差分析显示各后关节处连续测量3次痛阈差异均无统计学意义（P>0.05）。（3）保守治疗后患侧痛阈[（7.58±2.38）kg/cm2]和对侧腰椎后关节痛阈[（9.70±2.92）kg/cm2]均较治疗前[（4.93±2.04）kg/cm2，（7.19±2.62）kg/cm2]升高，但患侧仍低于对侧，且都低于正常组[（12.48±1.44）kg/cm2]；患侧T值、对侧T值在治疗前后差异有统计学意义（P<0.05），治疗后患侧T值与对侧T值差异有统计学意义（P<0.05），治疗后患侧T值、对侧T值与正常组T值差异有统计学意义（P<0.05）。（4）患者的主观疼痛强度越强，患侧后关节痛阈越低，随着主观疼痛强度减轻患侧腰椎后关节痛阈也随之升高：治疗前后VAS评分差异有统计学意义（P<0.05），治疗前后VAS评分和前后VAS评分差值与对应的患侧T值和对侧T值做多元回归分析示患侧T值的相关系数r均有统计学意义（P<0.05）、对侧T值相关系数的r均无统计学意义（P>0.05）。
结论：压力痛阈测试能准确地评估腰椎后关节处的疼痛强度及其变化特点，在腰椎间盘突出症中具有较好的临床应用价值。 |
| 【关键词】椎间盘移位 腰椎后关节 压力痛阈 保守治疗 |
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| Application of pain pressure threshold test in lumbar intervertebral disc herniation study |
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ABSTRACT
Objective: To quantify pain pressure threshold(PPT) in the patients with lumbar intervertebral disc herniation before and after treatment,and to study the clinical effects of the PPT test in lumbar intervertebral disc herniation.
Methods: From January to December 2017,59 patients with lumbar intervertebral disc hernation were treated,and another 59 normal persons were recruited as the normal control group. Visual analogue scale(VAS) was used to measure the patient's subjective pain intensity at admission,and the pain threshold of lumbar posterior joints was measured by the tenderness gauge. The pain threshold was measured three times with an interval of 1 min at the most painful posterior joints and the contralateral posterior joints,and the average value was recorded as the T-value. All patients were treated with one course of conservative treatment(Fengshi spine fixed-point rotation reduction plus routine dehydration and anti-inflammation). VAS score and pain threshold of posterior lumbar joints were measured after the treatment. One lumbar posterior joint was randomly selected in the normal control group to measure the pain threshold.
Results: (1)The patient group and the normal control group were comparable. There was no significant difference in age,body height,body weight and BMI between the two groups(P>0.05). (2) The pressure pain threshold test was consistent:variance analysis on the T-value before treatment[(4.72±2.14) kg/cm2,(4.96±2.10) kg/cm2,(5.11±2.09) kg/cm2] of the affected posterior joint,the T-value after treatment[(7.38±2.36) kg/cm2,(7.62±2.51) kg/cm2,(7.58±2.47) kg/cm2],the T-value of before treatment[(7.18±2.80) kg/cm2,(7.19±2.68) kg/cm2,(7.20±2.69) kg/cm2] of the contralateral posterior joint,T-value after treatment[(9.54±2.89) kg/cm2,(9.76±3.01) kg/cm2,(9.77±3.09) kg/cm2];and normal joint T-value[(12.23±1.56) kg/cm2,(12.51±1.48) kg/cm2,(12.6±1.63) kg/cm2] showed that there were no significant differences in the three successive measurements of pain threshold (P>0.05). (3) After conservative treatment,the pain threshold of the affected side[(7.58±2.38) kg/cm2] and the contralateral lumbar posterior joints[(9.70±2.92) kg/cm2] increased significantly,but T-value of the affected side was still lower than that of the contralateral side,and T-value of the both sides were lower than that of the normal group[(12.48±1.44) kg/cm2]. The T-value of the affected side and the contralateral side had significant difference between before and after treatment(P<0.05). After treatment,there was significant difference in T-value between the affected side and the contralateral side(P<0.05);there were significant differences in T-value among the affected side,contralateral side and the normal group(P<0.05). (4)Greater the subjective pain intensity of the patient was lower the posterior joint pain threshold of the affected side would be. As the subjective pain intensity decreased,the posterior joint pain threshold of the lumbar spine also increased. There was a significant difference in the VAS score before and after treatment(P<0.05). Multiple regression analysis showed that the correlation coefficient r between the VAS score before and after treatment and the corresponding T-value of the affected side were significantly different(P<0.05),and the corresponding T-value of the contralateral side were not significantly different(P>0.05).
Conclusion: The pressure pain threshold test can accurately evaluate the pain intensity and its changing patterns in the lumbar posterior joint. The pain pressure threshold test is clinically significantin the lumbar disc herniation. |
| KEY WORDS Intervertebral disk displacement Posterior lumbar joint Pressure pain threshold Conservative treatment |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 赵颀,朱纯正,杨欢,郭伟.压力痛阈测试在腰椎间盘突出症中的应用研究[J].中国骨伤,2020,33(5):435~439 |
| 英文格式: | ZHAO Xin,ZHU Chun-zheng,YANG Huan,and GUO Wei.Application of pain pressure threshold test in lumbar intervertebral disc herniation study[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(5):435~439 |
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