[1]宋卿鹏,田伟,何达,等.超声及电刺激引导下神经根封闭治疗腰椎退行性疾病导致的下肢放射痛[J].中医正骨,2018,30(06):44-46.
点击复制

超声及电刺激引导下神经根封闭治疗腰椎退行性疾病导致的下肢放射痛()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期数:
2018年06期
页码:
44-46
栏目:
临床报道
出版日期:
2018-06-20

文章信息/Info

作者:
宋卿鹏; 田伟; 何达; 周雁; 王晋超; 李祖昌; 冯啸
北京积水潭医院,北京 100035
关键词:
腰椎;  放射痛;  下肢;  超声检查;  电刺激;  封闭疗法;  脊神经根
文献标志码:
A
摘要:
目的:探讨超声及电刺激引导下神经根封闭治疗腰椎退行性疾病导致下肢放射痛的临床疗效和安全性。方法:2015年11月至2016年6月收治腰椎退行性疾病导致的下肢放射痛患者129例。男55例,女74例; 年龄(52.47±15.17)岁; 椎间盘突出87例,椎管狭窄28例,椎体滑脱7例,脊柱侧弯7例; 左侧下肢放射痛62例,右侧下肢放射痛67例。所有患者均经影像学检查确认存在神经根受压,下肢放射痛持续8周以上,经休息、理疗、非甾体类抗炎药及肌肉松弛药物治疗后均无明显改善。均无麻醉药物过敏史及腰椎、骶椎手术史,未合并马尾综合征、下肢肌力减退、凝血功能障碍及其他周围神经病变。均采用超声及电刺激引导下神经根封闭治疗。神经根封闭操作结束30 min后,采用视觉模拟量表(visual analogue scale,VAS)评定下肢疼痛程度,VAS评分较治疗前减少<50%则认为治疗节段为非责任节段,2 h后在其他节段再次行神经根封闭操作,并再次以VAS评定下肢疼痛程度。治疗后3 d,再次评定VAS评分。观察治疗后1年内患者接受手术治疗的情况及治疗和随访期间的并发症发生情况。结果:所有患者均顺利完成治疗,未发生硬膜穿孔、硬膜外血肿、神经损伤等严重并发症。L5神经根受压74例,S1神经根受压30例,L4神经根受压21例,L3神经根受压3例,L2神经根受压1例。中央管区压迫32例,外侧区域(椎间关节下区域、椎间孔区域、椎间孔外区域)压迫97例。治疗前下肢疼痛VAS评分为(7.58±0.61)分; 治疗后30 min,VAS评分为(0.89±1.05)分; 治疗后3 d,94例疼痛明显缓解(VAS评分较治疗前减少≥50%),VAS评分为(3.18±0.62)分,35例患者疼痛缓解不明显(VAS评分较治疗前减少<50%),VAS评分为(4.60±0.50)分。治疗后1年内,60例患者接受手术治疗(经椎间孔椎体间融合术或经皮椎间孔镜椎间盘切除术),其中治疗后3 d疼痛明显缓解者34例(34/94,36.17%)、治疗后3 d疼痛缓解不明显者26例(26/35,74.29%),椎间盘突出者34例(34/87,39.08%)、椎管狭窄者17例(17/28,60.71%)、椎体滑脱者5例(5/7,71.43%)、脊柱侧弯者4例(4/7,57.14%)。结论:超声及电刺激引导下神经根封闭是治疗腰椎退行性疾病导致下肢放射痛的一种安全有效方式,椎间盘突出导致的下肢放射痛及神经根封闭后短期内止痛效果好的患者预后较好。

参考文献/References:

[1] KARUNANAYAKE AL,PATHMESWARAN A,WIJAYARATNE LS.Chronic low back pain and its association with lumbar vertebrae and intervertebral disc changes in adults.A case control study[J].Int J Rheum Dis,2018,21(3):602-610. [2] TSUJIMOTO R,ABE Y,ARIMA K,et al.Prevalence of lumbar spondylosis and its association with low back pain among community-dwelling Japanese women[J].BMC Musculoskelet Disord,2016,17(1):493. [3] PALACIOS-CEÑA D,ALONSO-BLANCO C,HERNÁNDEZ-BARRERA V,et al.Prevalence of neck and low back pain in community-dwelling adults in spain:an updated population-based national study(2009/10-2011/12)[J].Eur Spine J,2015,24(3):482-492. [4] GHANEI I,ROSENGREN BE,HASSERIUS R,et al.The prevalence and severity of low back pain and associated symptoms in 3,009 old men[J].Eur Spine J,2014,23(4):814-820. [5] RUDOL G,RICHARDSON D,KASIS A,et al.Clinical usefulness and safety of selective lumbar nerve root blocks[J].Spine Journal,2016,16(4):51. [6] MANSON NA,MCKEON MD,BIGNEY E,et al.A randomized control trial evaluating the effectiveness of selective nerve root injections in patients with lumbar disc herniation[J].The Spine Journal,2016,16(10):289. [7] KANAYAMA M,OHA F,HASHIMOTO T.What types of degenerative lumbar pathologies respond to nerve root injection?A retrospective review of six hundred and forty one cases[J].Int Orthop,2015,39(7):1379-1382. [8] YAMADA K,NAKAMAE T,SHIMBO T,et al.Targeted therapy for low back pain in elderly degenerative lumbar scoliosis[J].Spine(Phila Pa 1976),2016,41(10):872-879. [9] EASTLEY NC,SPITERI V,NEWEY ML.Variations in selective nerve root block technique[J].Ann R Coll Surg Engl,2013,95(7):515-518. [10] RATHMELL JP,BENZON HT,DREYFUSS PA,et al.Safeguards to prevent neurologic complications after epidural steroid injections consensus opinions from a multidisciplinary working group and National organizations[J].Anesthesiology,2015,122(5):974-984. [11] GHARAEI H.Transforaminal epidural block or selective nerve root block?[J].Anaesthesia,2015,2(3):110-112. [12] SATO M,SIMIZU S,KADOTA R,et al.Ultrasound and nerve Stimulation-guided L5 nerve root block[J].Spine(Phila Pa 1976),2009,34(24):2669-2673. [13] SATO M,MIKAWA Y,MATUDA A.Ultrasound and electrical nerve stimulation-guided S1 nerve root block[J].J Anesth,2013,27(5):775-777. [14] CHUMNANVEJ S,WETCHAGAMA N,KOUNSONGTHAM V.Accuracy of needle-tip localization by ultrasound guidance lumbar selective nerve root block:a prospective clinical study of 78 lumbar nerve roots block[J].J Med Assoc Thai,2011,94(12):1451-1456. [15] LOIZIDES A,GRUBER H,PEER S,et al.Ultrasound guided versus CT-controlled pararadicular injections in the lumbar spine:a prospective randomized clinical trial[J].AJNR Am J Neuroradiol,2013,34(2):466-470. [16] KIM YH,PARK HJ,MOON DE.Ultrasound-guided pararadicular injection in the lumbar spine:a comparative study of the paramedian sagittal and paramedian sagittal oblique approaches[J].Pain pract,2015,15(8):693-700. [17] PFIRRMANN CW,OBERHOLZER PA,ZANETTI M,et al.Selective nerve root blocks for the treatment of sciatica:evaluation of injection site and effectiveness—a study with patients and cadavers[J].Radiology,2001,221(3):704-711. [18] HADJERCI O,HAFIANE A,MORETTE N,et al.Assistive system based on nerve detection and needle navigation in ultrasound images for regional anesthesia[J].Expert Systems with Applications,2016,61:64-77.[19] LUO QE,YAO WF,SHU HH,et al.Double-injection technique assisted by a nerve stimulator for ultrasound-guided supraclavicular brachial plexus block results in better distal sensory-motor block A randomised controlled trial[J].Eur J Anaesthesiol,2017,34(3):127-134. [20] BRULL R,MCCARTNEY CJ,CHAN VW,et al.Neurological complications after regional anesthesia:contemporary estimates of risk[J].Anesth Analg,2007,104(4):965-974. [21] STALCUP ST,CRALL TS,GILULA L,et al.Influence of needle-tip position on the incidence of immediate complications in 2,217 selective lumbar nerve root blocks[J].Spine Journal,2006,6(2):170-176. [22] MACNAB I.Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients[J].J Bone Joint Surg Am,1971,53(5):891-903. [23] LAVELLE WF,MROZ T,LIEBERMAN I.The Incidence of Lumbar Discectomy after Epidural Steroid Injections or Selective Nerve Root Blocks[J].Int J Spine Surg,2015,9:12. [24] MALLINSON PI,TAPPING CR,BARTLETT R,et al.Factors that affect the efficacy of fluoroscopically guided selective spinal nerve root block in the treatment of radicular pain:a prospective cohort study[J].Can Assoc Radiol J,2013,64(4):370-375.

相似文献/References:

[1]刘彦璐,林耐球,李绍旦,等.正骨手法结合中药外敷治疗腰椎间盘突出症[J].中医正骨,2015,27(02):26.
[2]邵礼晖,潘浩.Coflex棘突间动态稳定系统治疗腰椎退变性疾病40例[J].中医正骨,2015,27(02):37.
[3]郭新军,朱卉敏,王衡,等.一次性纤维环缝合器在腰椎间盘突出症髓核摘除术中的应用[J].中医正骨,2015,27(03):59.
[4]林斌,黎秋生,何勇,等.椎弓根螺钉单侧固定与双侧固定治疗腰椎间盘突出症 对邻近节段退变的影响[J].中医正骨,2015,27(01):16.
　LIN Bin,LI Qiusheng,HE Yong,et al.Effect of unilateral versus bilateral fixation with pedicle screws on adjacent segment degeneration in patients with lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(06):16.
[5]王世龙.腰椎椎管内外痛风石1例[J].中医正骨,2012,24(02):69.
[6]秦杰,李振宇.三法十式手法配合中药腰痹汤治疗腰椎间盘突出症[J].中医正骨,2011,23(02):71.
[7]颜 峰.椎间融合术配合中药外敷治疗退行性腰椎滑脱症[J].中医正骨,2016,28(01):38.
[8]贾龙,张华.“治未病”思想指导下腰椎间盘突出症的辨证防治[J].中医正骨,2017,29(01):36.
[9]姜文涛,梅伟,王庆德,等.腰椎融合术后邻近节段退变的影响因素分析[J].中医正骨,2017,29(03):3.
　JIANG Wentao,MEI Wei,WANG Qingde,et al.Analysis of factors influencing adjacent segment degeneration after lumbar spinal fusion[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(06):3.
[10]聂富祥,贺海怿,朱文辉,等.一次性可扩张通道下微创经椎间孔入路腰椎间融合术治疗单节段腰椎退行性疾病[J].中医正骨,2017,29(05):34.

更新日期/Last Update: 2018-10-30