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目的比较椎间盘激光修复术与硬脊膜外腔激素注射(ESI)治疗腰椎间盘突出引发根性坐骨神经痛的疗效。方法将94例患者按1∶1随机分入椎间盘激光修复术组(激光组)和ESI组,每组47例。主要评估指标包括腰痛ODI(the oswestry disability index)评分和疼痛数字模拟评分(NRS评分)。结果在随访8周时,两组的ODI评分、NRS评分均显著低于同组基线值(P值均<0.05),且激光组ODI评分的下降程度较ESI组更为显著(校正后两组差异为-2.83,95%CI为-5.48~-0.18,P=0.04),但两组间NRS评分下降程度的差异无统计学意义(P>0.05)。在随访52周时,两组的ODI评分、NRS评分均显著低于同组基线值(P值均<0.05),且激光组ODI评分(校正后两组差异为-8.45,95%CI为-12.23~-4.66,P<0.01)和NRS评分(校正后两组差异为-0.70,95%CI为-1.26~-0.14,P=0.02)的下降程度均较ESI组更加显著。两组间在随访8和52周时总体康复率的差异均无统计学意义(P值均>0.05)。两组患者均无严重不良事件发生。结论椎间盘激光修复术治疗根性坐骨神经痛患者的疗效较ESI治疗更佳,但本研究结果的推广存在一定局限性。
Objective To compare the efficacy of disc laser repair and epidural injection (ESI) in the treatment of lumbar disc herniation caused by radical sciatica. Methods Ninety-four patients were randomly divided into two groups: the laser group and the ESI group, with a ratio of 1: 1, with 47 cases in each group. Key assessment indicators included the oswestry disability index (ODI) and digital pain score (NRS score). Results At the 8th week of follow-up, the ODI and NRS scores of the two groups were significantly lower than those of the same group (all P <0.05), and the ODI scores of the laser group decreased more significantly than those of the ESI group The difference was -2.83, the 95% CI was -5.48 ~ -0.18, P = 0.04). However, there was no significant difference in the decline of NRS between the two groups (P> 0.05). At 52 weeks follow-up, ODI scores and NRS scores of the two groups were significantly lower than those of the same group (all P <0.05), and ODI scores of the laser group (-8.45, 95% CI - 12.23 ~ -4.66, P <0.01) and NRS scores (-0.70 after correction, 95% CI -1.26 ~ -0.14, P = 0.02). There was no significant difference in the overall rate of recovery between the two groups at 8 and 52 weeks of follow-up (P> 0.05). No serious adverse events occurred in both groups. Conclusion The efficacy of disc laser repair in patients with radical sciatica is better than that of ESI, but the promotion of this study has some limitations.