腰椎后路融合术后骶髂关节痛的关节内外联合神经阻滞治疗  

Diagnosis and treatment of sacroiliac joint pain with a technique combining intra- and peri-articular injection after lumbar fusion surgery

作　　者：夏新雷 许灏铖 张帆 邵明昊 王洪立 马晓生 吕飞舟[2] 姜建元 

机构地区：[1]复旦大学附属华山医院骨科,上海200040 [2]复旦大学附属第五人民医院骨科,上海200240

出　　处：《中华骨科杂志》2018年第3期150-155,共6页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81472036）

摘　　要：目的 探讨腰椎后路融合术后骶髂关节痛的发病机制及骶髂关节内外联合神经阻滞治疗的疗效。方法 回顾性分析2013年1月至2016年12月收治的腰椎后路融合术后出现腰臀部疼痛的患者35例,通过临床症状、体征及诱发试验等明确疼痛源于骶髂关节。男20例,女15例;年龄48~75岁,平均（60.1±7.74）岁。腰椎后路融合术前诊断为腰椎间盘突出症9例、腰椎管狭窄症22例、腰椎退变性滑脱症4例;单节段融合10例、双节段融合16例、三节段及三节段以上融合9例。腰椎后路融合术所有患者均未取自体髂骨。17例采用骶髂关节内神经阻滞术（关节内神经阻滞组）、18例采用骶髂关节内外联合神经阻滞术（关节内外联合神经阻滞组）治疗。关节外阻滞点选择骶髂关节下缘上方约1 cm处。术后2周进行随访,评估两组患者疼痛模拟评分 （visual analogue scale,VAS）及Oswestry功能障碍指数（Oswestry disability index,ODI）恢复率的差异。结果 术前两组患者性别、融合节段位置、融合节段数量、VAS评分及ODI评分之间的差异无统计学意义（P〉0.05）。术后即刻关节内外联合神经阻滞组VAS评分恢复率大于关节内神经阻滞组,差异有统计学意义（t=2.159,P=0.038）;术后2周关节内外联合神经阻滞组的VAS评分及ODI评分恢复率均大于关节内神经阻滞组（t=2.705,P=0.011;t=2.156,P=0.039）。结论 腰椎后路融合术后骶髂关节痛可由骶髂关节内外联合病变引起,单纯骶髂关节内神经阻滞术可能无法达到最佳的临床疗效。选择在骶髂关节下缘上方约1 cm处行关节外神经阻滞,联合关节内神经阻滞可提高术后早期镇痛效果。Objective To investigate the mechanisms of sacroiliac joint pain after lumbar fusion surgery and to present the clinical outcomes after a combining intra- and peri-articular injection. Methods Totally 20 male and 15 female patients （48-75 years old） from January 2013 to December 2016 were retrospectively included in the present study. The patients were all with sustained low back and hip pain after prior posterior lumbar interbody fusion surgery. Nine cases were diagnosed with lumbar disc herniation, 22 cases with lumbar stenosis, and 4 cases with degenerative lumbar spondylolisthesis. Ten cases were performed with single level fusion, 16 cases with two level fusion, 9 cases with 3 or more level fusion. Autogenous iliac bone graft was not applied in any of those patients. The pain of the patients was confirmed from the sacroiliac joint through specific symptoms and signs. They were divided into two groups and were treated with either standard intra-articular injection （17 cases） or a combine of intra- and peri-articular sacroiliac injection （18 cases）. Peri-articular injection was conducted at 1 cm above the inferior margin of the sacroiliac joint. Recover ratios of visual analogue scale （VAS） and Oswestry disability index （ODI） at 2 weeks post-operatively were recorded and were compared between the two groups. Results No statistical difference was found in gender, fusion location, fusion levels, pre-operative VAS and ODI score between the two groups （P〉0.05）. The combination of intra- and peri-articular sacroiliac injection showed significantly better Results than the single intra-articular injection in VAS score immediately after injection （t=2.159, P=0.038）, VAS score at 2 weeks after injection and ODI score at 2 weeks after the injection （t=2.705, P=0.011; t=2.156, P=0.039, respectively）. Conclusion Both intra- and extra- sacroiliac joint diseases may lead to sacroiliac joint pain after lumbar fusion surgery. A single intra-articular sacroiliac injection could not provide opt

关 键 词：脊柱融合术 骶髂关节 疼痛 手术后 

分 类 号：R687.3[医药卫生—骨科学]