颈椎硬膜外阻滞在交感型颈椎病诊治中的应用  

Cervical epidural blockage in diagnosis and treatment of sympathetic cervical spondylosis

作　　者：叶春平[1] 朱家骏[1] 郑文寅[1] 陈有芬[1] 冷燕奎[1] 吕机生[1] 

机构地区：[1]金华市人民医院骨科,321000

出　　处：《浙江医学》2008年第10期1064-1065,1134,共3页Zhejiang Medical Journal

摘　　要：目的探讨颈椎硬膜外阻滞对交感型颈椎病的诊断价值和治疗效果。方法将临床拟诊为交感型颈椎病的93例患者,按随机数字表法分成3组,每组31例:A、B组均先用0.5%利多卡因5ml作颈椎硬膜外阻滞并置管;药效过后重新出现症状后经导管注入0.9%氯化钠注射液5ml;A组第2天经导管注入复方倍他米松注射液,B组不再注入;C组未进行颈椎硬膜外阻滞。3组患者均用颈围制动1个月并进行长期规律的颈项背肌锻炼。统计分析各组患者的诊断阳性率及治疗优良率。结果A组和B组临床误诊率分别为12.91%(4/31)和16.13%(5/31)。A组治疗3个月、1年后优良率(72.42%、89.66%)明显高于B组(43.33%、46.67%)和C组(44.44%、48.15%),差异均有统计学意义(均P<0.05),而B组和C组的差异无统计学意义(P>0.05)。结论颈椎硬膜外阻滞对交感型颈椎病的诊断具有重要价值,颈椎硬膜外注射复方倍他米松注射液结合短期的颈部制动和长期的颈项背肌锻炼是治疗交感型颈椎病的有效方法。Objective To investigate the value and outcome of cervical epidural blockage in diagnosis and treatment of sympathetic cervical spondylosis. Methods A prospective study was performed on 93 patients with sympathetic cervical spondylosis, who were diagnosed clinically. Ninety three patients were randomly divided into 3 groups with 31 in each. The patients in group A and B were injected with 5ml 0.5% lidocain through cervical epidural tube,then injected with 5ml 0.9% normal saline after sympathetic symptoms recurred; patients in group A were injected with beta-methasone through cervical epidural tube in the second day; patients group C did not receive cervical epidural blockage. All 3 groups were followed by immobilization with neck collar for 1 month and regular exercise of neck and back muscles. Results The misdiagnosis rate with sympathetic cervical spondylosis was 12.91% （4/31） in group A and 16.13%（5/31 ）in group B. Rate of excellent and good outcome of 3 month and 1 year treatment in group A was 72.42% and 89.66%,while those were 43.33% and 46.67% in group B, 44.44% and 48.15% in Group C, respectively. There were significant differences between the rate in group A and that in group B and C （P〈0.05）, while there was no statistical significance between group B and group C （P〉0.05）. Conclusion Cervical epidural blockage is of value in diagnosis and treatment of sympathetic cervical spondylosis; and cervical epidural blockage combined with exercise of neck and back muscles .is an effective method to cure sympathetic cervical spondylosis.

关 键 词：交感型颈椎病 颈椎不稳定 炎性介质 硬膜外阻滞 项背肌锻炼 

分 类 号：R681.55[医药卫生—骨科学] R614.42[医药卫生—外科学]