超声引导下经颈椎椎间孔行硬脊膜外腔阻滞治疗神经根型颈椎病的效果  

Efficacy of ultrasound-guided cervical transforaminal epidural block on cervical radiculopathy

作　　者：施海峰[1,2] 张昕[3] 吕莹莹[3] 浦少锋[3] 徐永明[3] 周瑾[3] 杜冬萍[3] 

机构地区：[1]同济大学医学院,上海200092 [2]上海市第一人民医院分院麻醉科 [3]上海交通大学附属第六人民医院疼痛中心

出　　处：《上海医学》2016年第6期326-330,I0001,共6页Shanghai Medical Journal

摘　　要：目的探讨超声引导下经颈椎椎间孔行硬脊膜外腔阻滞治疗神经根型颈椎病的可行性、安全性和有效性。方法选择2014年4月—2015年4月在上海交通大学附属第六人民医院疼痛科明确诊断为神经根型颈椎病的患者60例,男33例、女27例,年龄30~70岁,平均年龄为(44±11)岁。采用随机数字表法将患者分入超声引导下经颈椎椎间孔行硬脊膜外腔阻滞组(硬脊膜外腔阻滞组)和超声引导下颈神经根阻滞组(颈神经根阻滞组),每组30例。记录患者治疗前1d、治疗后30min,以及治疗后2、4、8周的疼痛视觉模拟评分(VAS评分);记录两组中治疗次数≥2次的患者例数。观察两组注射造影剂后颈神经根和颈椎硬脊膜外腔的显影情况,并实时监测造影剂血管内注射情况。记录两组患者在治疗过程中的并发症发生情况。记录两组术后8周仍需服用药物缓解疼痛的患者例数。结果两组治疗后30min,以及治疗后2、4、8周的疼痛VAS评分均显著低于同组治疗前(P值均<0.01)。两组间治疗前1d和治疗后30min的疼痛VAS评分的差异均无统计学意义(P值均>0.05),硬脊膜外腔阻滞组治疗后2、4、8周的疼痛VAS评分均显著低于颈神经根阻滞组同时间(P值均<0.01)。硬脊膜外腔阻滞组治疗次数≥2次和8周后仍需服用药物缓解疼痛的患者例数均显著少于颈神经根阻滞组(P值均<0.01)。两组注射造影剂后神经根均显影良好;硬脊膜外腔阻滞组硬脊膜外腔显影较好23例、显影失败7例,颈神经根阻滞组无1例硬脊膜外腔显影;两组均未发生造影剂血管内注射情况。两组均无患者发生气胸、局部麻醉药中毒、全脊髓麻醉、感染等并发症。结论超声引导下经颈椎椎间孔行硬脊膜外腔阻滞和超声引导下颈神经根阻滞治疗神经根型颈椎病均安全、有效,其中经颈椎椎间孔行硬脊膜外腔阻滞的效果更佳。Objective To evaluate the feasibility, safety and effectiveness of ultrasound-guided cervical transforaminal epidural block for cervical radiculopathy. Methods A total of 60 patients with cervical radiculopathy diagnosed in the Pain Management Center of Shanghai Sixth People＇s Hospital from April 2014 to April 2015 were enrolled in this study. There were 33 males and 27 females with an average age of （44 ± 11） years old （range, 30-70 years old）. They were randomly divided into 2 groups： ultrasound-guided cervical transforaminal epidural block group （n = 30） and ultrasound-guided cervical nerve root block group （n=30）. Visual analogue scale （VAS） score was recorded at 1 day before treatment and 30 minutes, 2 weeks, 4 weeks and 8 weeks after treatment. The number of cases with more than one treatment was also recorded. The spread of contrast agent to the nerve root and epidural space after injection was observed, and intravascular injection was real-time monitored. Incidence of adverse reactions was also recorded during the course of treatment. The number of patients taking analgesics to control pain at 8 weeks after treatment was recorded. Results VAS scores at 30 minutes and 2, 4, 8 weeks after treatment in the two groups were significantly lower than those before treatment （all P〈0.01）. There were no significant difference in VAS score at 1 day before treatment or 30 minutes after treatment between the two groups （all P 〉 0. 05）. VAS score at 2, 4 and 8 weeks after treatment were significantly lower in the epidural block group than those in the nerve root block group （all P〈0.01）. The number of cases with more than one treatment in the epidural block group was significantly less than that in the nerve root block group （P^0.01）. Less patients still needed to take analgesics at 8 weeks after treatment in the epidural block group than nerve root block group （P〈0.01）. The nerve root developed well after injection of contrast agent in both groups. The contrast agen

关 键 词：超声 椎间孔 硬脊膜外腔阻滞 神经根型颈椎病 

分 类 号：R614.4[医药卫生—麻醉学]