选择性神经根封闭术在多节段腰椎疾病定位诊断及有限手术中的应用  

Application of selective nerve root block in diagnosis and limited operative treatment for multi-segmental lumbar diseases

作　　者：胡强[1] 杨小龙[1] 于鑫[2] 马艳[1] 连文文[1] 李少辉[1] 欧华西[1] 王成润[1] 宋恒平[1] 王平均[1] 

机构地区：[1]解放军第123医院骨一科,安徽蚌埠233015 [2]泰安市中心医院脊柱骨科

出　　处：《中国骨与关节损伤杂志》2017年第5期475-478,共4页Chinese Journal of Bone and Joint Injury

基　　金：南京军区面上课题(14MS041)

摘　　要：目的探讨选择性神经根封闭术对确定多节段腰椎退行性疾病责任节段的诊断意义,观察后续有限手术的疗效。方法回顾性分析自2014-07—2014-12诊治的临床体征不典型且多节段退变的18例腰椎退行性疾病,采用选择性神经根封闭术明确责任节段,并在此基础上选择手术减压或融合的节段。比较术前、术后7 d、3个月、12个月及末次随访时的VAS和JOA评分。结果选择性神经根封闭术确定责任节段的准确率明显高于MRI检查,差异有统计学意义(P<0.05)。18例术后均获得(15.6±3.1)个月随访,均无残留下肢神经根症状。术后7 d、3个月、12个月及末次随访时的VAS评分、JOA评分较术前明显改善,差异有统计学意义(P<0.05);且术后7 d、3个月、12个月及末次随访的VAS评分、JOA评分比较差异均无统计学意义(P>0.05)。结论对于定位不明确的多节段腰椎退行性疾病患者,术前通过选择性神经根封闭术明确责任节段,再采取个体化的手术方式治疗,既保证了术后效果及长期的脊柱稳定性,也避免了预防性减压和长节段融合带来的手术创伤和远期并发症。Objective To investigate the diagnostic value of selective nerve root block in the treatment of multiple segment lumbar degenerative diseases. Methods Eighteen cases of lumbar degenerative diseases with atypical clinical signs and multi segment degeneration, treated from July 2014 to December 2014 with selective nerve root block for confirmation of responsibility segments on the basis of surgical decompression or fusion segment, were retrospectively analyzed. The VAS and JOA scores were compared before and 7 d, 3 months, 12 months after operation, and at the end of the follow-up period. Results The accuracy of selective nerve root block in determining responsibility segments was significantly higher than that of MRI examination, the difference was statistically significant（P 〈0.05）. All 18 patients were followed up for （15.6±3.1） months, no residual nerve root symptoms were observed. Seven days, 3 months, 12 months after operation and at last follow-up, the VAS score and JOA score were significantly improved compared with those before operation, the difference was statistically significant （P 〈0.05）. Seven days, 3 months, 12 months after operation and at last follow-up, there were no statistically significant differences in the VAS score and JOA score （P 〉0.05）. Conclusion For patients with responsibility segment-undefined multi segmental lumbar degenerative diseases, preoperative selective nerve root block can locate the responsibility segment. Then the individual surgical treatment can ensure the postoperative effect and the long-term stability of the spine, and can also avoid the trauma caused by preventive decompression and long segmental fusion and the long term complications as well.

关 键 词：腰椎退行性疾病 多节段 选择性神经根封闭术 责任节段 有限手术 

分 类 号：R681.5[医药卫生—骨科学]