摘要
目的观察经椎间盘神经阻滞治疗腰椎间盘突出症的临床效果。方法回顾性分析2015年9月至2017年8月采用神经阻滞技术治疗的107例腰椎间盘突出症患者的临床资料,其中56例经椎间盘神经阻滞(经椎间盘组),51例经椎间孔选择性神经根阻滞(经椎间孔组)51例。所有患者均在透视引导下行腰椎间盘穿刺或行椎间孔穿刺,穿刺成功后局部注射复方倍他米松+盐酸利多卡因。治疗前、治疗后即刻、治疗后3个月进行疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)评估,治疗后3个月随访时进行MacNab评定。结果经神经阻滞治疗后两组患者症状均有不同程度的改善,腰痛VAS评分和ODI指数治疗前后比较两组差异均有统计学意义(P<0.001),两组组间比较差异无统计学意义(P>0.05)。按照MacNab疗效评定标准,经椎间盘组末次随访时总有效率100%,优良率75%;经椎间孔组末次随访时总有效率96%,优良率71%。经椎间盘组1例出现穿刺部位感染,经口服抗生素及休息治疗后症状缓解。结论经椎间盘神经阻滞治疗腰椎间盘突出症是种有效的治疗方法,可以作为常规保守治疗的有益补充,但其作为一种有创性操作,可能导致椎间隙感染等严重并发症,在临床应用中需谨慎选择。
Objective To investigate the therapeutic efficacy of intervertebral disc nerve block in the treatment of lumbar disc herniation.Methods The clinical data of 107 patients with lumbar disc herniation treated with nerve block between September 2015 and August 2017 were reviewed retrospectively.Among them,56 undergoing intervertebral disc injection with the guidance of fluoroscopy were assigned as IDI group and the other 51 cases undergoing transforaminal epidural injection with the guidance of fluoroscopy as TEI group.The compound of betamethasone+lidocaine was injected into the intervertebral discs in the IDI group,and into the transforaminal epidural spaces in the TEI group as well.Visual analogue scale(VAS)and Oswestry dysfunction index(ODI)assessments were performed before treatment,immediately after treatment and 3 months after treatment.MacNab scoring was performed at 3 months follow-up after treatment.Results All patients'symptoms were improved after treatment.The scores by VAS scores and ODI immediately and 3 months after treatment were significantly lower than those before treatment(P<0.05)both in IDI group and TEI group,but the scores were not significantly different between the two groups(P>0.05).According to the MacNab efficacy evaluation criteria,the total effectiveness rate was 100% in IDI group and 96% in TEI group,and the rate of being excellent and good was 75% in IDI group and 71% in TEI group.One patient in IDI group was complicated with infection after treatment and got healed after oral antibiotics and rest treatment.Conclusions Intervertebral disc nerve block is an effective treatment for lumbar disc herniation.It can be used as a supplement of conservative treatment methods.It is a traumatic manipulation which could lead to infection of intervertebral disc,accelerated disc degeneration and other serious complications,so surgeons should be cautious when deciding to adopt this approach.
作者
林秋水
吴晓东
王建喜
臧法智
陈华江
LIN Qiushui;WU Xiaodong;WANG Jianxi;ZANG Fazhi;CHEN Huajiang(Department of Spine Surgery,the First Affiliate Hospital,Navy Medical University,Shanghai 200433,China;不详)
出处
《实用医学杂志》
CAS
北大核心
2023年第14期1804-1808,共5页
The Journal of Practical Medicine
基金
上海市虹口区卫生和计划生育委员会医学科研课题(编号:虹卫1703-26)。
关键词
椎间盘突出症
腰椎退变
椎间盘
神经阻滞
disc herniation
lumbar intervertebral degeneration
intervertebral disc
nerve block
作者简介
通信作者:陈华江,E-mail:spine.chen@163.com。
