中文摘要：

目的观察快速牵引联合骶裂孔硬膜外阻滞治疗腰椎间盘突出症的临床疗效，并探讨其治疗的作用机制，为该病的临床治疗提供依据。方法选择2006年1月至2009年1月在山东大学齐鲁医院康复医学科就诊且适合非手术治疗的腰椎间盘突出症患者450例，按照就诊顺序将所有患者分为慢速牵引组、快速牵引组和快速牵引加骶裂孔硬膜外阻滞组（联合组），其中慢速牵引组接受1个疗程的腰椎慢速牵引，快速牵引组接受1次腰椎快速牵引，联合组接受1次腰椎快速牵引加骶裂孔硬膜外阻滞。应用日本整形外科协会（JOA）推荐的腰椎疾患治疗成绩评分表及目测类比评分法（VAS）对患者治疗前及治疗后1个月进行评分，观察其临床疗效，并对患者随访1年，观察其复发率。结果治疗前，3组JOA及VAS评分比较，差异无统计学意义（P〉0．05）；经过治疗后，3组的JOA及VAS评分均明显改善，且组间差异具有统计学意义（P〈0．05）。慢速牵引组、快速牵引组和联合组的总有效率分别为63．3％、90．7％和94．0％，联合组优于快速牵引组（P〈0．01），快速牵引组优于慢速牵引组（P〈0．01）。随访1年，3组的复发率比较，慢速牵引组最高（20．7％），快速牵引组其次（14．0％），联合组最低（8．7％），差异有统计学意义（P〈0．05）。结论快速牵引配合骶裂孔硬膜外阻滞治疗腰椎间盘突出症具有良好的治疗效果，优于单纯快速牵引及慢速牵引。

英文摘要：

Objective To observe the clinical efficacy of three-dimensional rapid traction combined with sacral hiatus epidural blocking for the treatment of lumbar disc herniation （LDH）. Methods A total of 450 patients with LDH were divided into three groups. Group A received conventional slow traction, group B received three-dimensional rapid traction, and group C received sacral hiatus injections for epidural blocking combined with three-di- mensional rapid traction. The Japanese Orthopadedic Association （JOA） scale for lumbar disease and a visual analogue scale （VAS） were used to evaluate the treatment effect and the patients＇ subsequent quality of life. All of the patients were followed up for 1 year and evaluated using standard clinical evaluations. Results The average VAS scores and JOA scores of the three groups were not significantly different before treatment, and all had significantly improved after treatment. The overall effectiveness rates were 63.33% for group A, 90.67% for group B and 94% for group C, and these differences were all statistically significant. After one year the recurrence rates in the A, B and C groups were 20.7% , 14.0% and 8.7% respectively, and these differences were again statistically significant. Conclusion Sacral hiatus epidural blocking combined with three-dimensional rapid traction showed good therapeutic effect and safety for LDH patients and was superior to simple rapid traction or slow traction.