目的：观察骶管注射配合核心肌群稳定性训练治疗老年人腰椎间盘突出症（ LDH）的疗效。方法选择2012年1月-2013年6月广州市第一人民医院诊治的老年LDH患者90例，按随机数字表法将其分为3组：骶管注射组（A组）、运动治疗组（B组）及核心肌群稳定性治疗组（C组），每组30例。3组均给予骶管注射治疗，即通过骶管注射由0.9％氯化钠无菌水溶液、利多卡因注射液、碳酸氢钠注射液及醋酸曲安奈德注射液等组成的混合液体20 ml，1次/周，共计3次。B组及C组在骶管注射治疗的基础上再给予各自的间歇性运动训练，30 min/次，2次/d，连续3周。于治疗前及治疗后使用改良的日本矫形外科学会改良腰痛评分法（ M-JOA）和疼痛视觉模拟评分（ VAS）进行临床疗效评价。结果治疗前，3组患者 M -JOA 评分、VAS 间无差异（ P ＞0.05）；治疗3周后， B 组、C 组M-JOA评分、VAS低于A组，而M-JOA评分改善率高于A组（P＜0.05）；C组M-JOA评分改善率高于B组，VAS低于B组（P＜0.05）。结论骶管注射治疗后，配合腰背肌或腹肌的相关运动训练均是治疗老年LDH的有效疗法，但骶管注射疗法配合核心肌群稳定性训练的疗效最好。%Objective To observe the curative effects of sacral injection and core stabilization exercises in treatment of old patients with lumbar disc herniation. Methods 90 old patients with lumbar disc herniation who were treated in the First Peo-ple's Hospital of Guangzhou from January 2012 to June 2013,were randomly divided into three groups by random number table method:sacral injection therapy(SIT)group(A group),exercise training group(B group)and core stabilization exercises group(C group),with 30 patients in each group. Patients in three groups received SIT(20 ml mixed liquor of 0. 9% sodium chloride solution,lidocaine injection,sodium bicarbonate injection and triamcinolone acetonide acetate injection was injected through sacral canal,1 time per week for totally 3 times). On the basis of SIT,B group and C group received intermittent exer-cise training( B group received interval training,C group received core stabilization exercises),30 minutes per time,2 times per day for 3 weeks totally. All the patients were evaluated by M-JOA and VAS before injection and after injection. Results There was no significant difference in M -JOA and VAS scores among 3 groups before treatment ( P >0. 05 );3 weeks after treatment,scores of M-JOA and VAS in B group and C group were significantly lower than those in A group,M-JOA score im-provement rate in B group and C group was significantly higher than that in A group ( P<0. 05 );M-JOA score improvement rate in C group was significantly higher than that in B group,VAS in C group was significantly lower than that in B group( P<0. 05). Conclusion After SIT,exercise training of low back and abdominal muscles is effective in treatment of old patients with lumbar disc herniation,SIT and core stabilization exercises work best.
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