经骶裂孔硬膜外前间隙穿刺置管1047例回顾总结  

THE REVIEW OF 1047 PATIENTS PUNCTURED FROM ANTERIOR EPIDURAL SPACE VIA HIATUS SACRALIS

作　　者：刘延青[1] 王平 牟桂玲 张少臣[3] 安玉风 赵娜 

机构地区：[1]中华疼痛学会第二临床中心北京天坛医院疼痛诊疗中心,北京100050 [2]北京铁路中心医院疼痛科 [3]长春中医学院附属医院疼痛科 [4]河北省高碑店市延安疼痛病院

出　　处：《中国疼痛医学杂志》2004年第6期332-334,共3页Chinese Journal of Pain Medicine

基　　金：首都医学发展基金特色专业项目(首都TS199906)

摘　　要：目的回顾总结骶裂孔穿刺置管失败的发生率及改行后路硬膜外前侧间隙穿刺置管的有关问题。方法对骶裂孔穿刺、置管失败的病例进行统计,并参考其术前骶尾侧位片、术中监测X线造影片,分析骶裂孔穿刺失败原因。计算首次置管达后间隙及发生脊麻的比率,并对采用后路硬膜外前侧间隙法的病例进行1年远期疗效随访。结果在X线下首选骶裂孔前间隙法穿刺失败率7.54%,置管失败率为0.94%,首次置管达后间隙的发生率为3.63%,脊麻的发生率为2.06%,其中延迟性脊麻的发生率为1.22%。随访44例后路法患者1年远期疗效的优良率为84.09%,总有效率为97.73%。结论经骶裂孔硬膜外前间隙穿刺置管注射胶原酶是治疗腰椎间盘突出症患者一安全有效的途径;骶尾侧位片有助于确定骶裂孔及骶管有无畸形。Aim: To summarize the fail rate of puncturing via hiatus sacralis and catheterizing to anterior epidural space. We analyzed the failure cases by reading the radiogram of sacrum and coccyx before chemonucleolysis and watching the peridurogram during chemonucleolysis to find the reason of failure. One year follow up review to 44 patients was conducted, who were punctured via poster median interspace to epidural space and catherized to anterior or lateral epidural space. Result: The failure rate of which the patients were punctured and cathetered via hiatus sacralis was 7.54% and 0.94% respectively. The failure rate of the firstly cathetering to posterior epidural space via hiatus sacralis was 3.63%, the rate of spinal anesthesia was 2.06%. After one year, the curative and excellent rate of 44 patients was 84.09%, and the total effective rate was 97.73%. Conclusion: The extra disc injection of collagenase from anterior epidural space via hiatus sacralis is an effective method for the treatment of lumbar disc herniation. The radiogram of sacrum and coccyx is useful to find malformation of hiatus sacralis.

关 键 词：经骶裂孔硬膜外前间隙穿刺置管 治疗 腰椎间盘突出症 胶原酶 

分 类 号：R681.53[医药卫生—骨科学]