术中应用曲安奈德对腰椎间盘突出症术后早期神经根水肿反应性疼痛的影响  

Alleviation of root pain caused by early postoperative edema reaction of lumbar intervertebral disc herniation with application of triamcinolone acetonide during surgery

作　　者：岑毕文 尚晖[1] 常巍[1] 郭振鹏[1] 杨棋[1] SHANG Hui;CHANG Wei;GUO Zhenpeng;YANG Qi(Department of Spine Surgery, Taihe Hospital, Hubei Medical University, Shiyan 442000, China)

机构地区：[1]十堰市太和医院(湖北医药学院附属医院)脊柱外科,湖北十堰442000

出　　处：《骨科》2017年第2期95-98,共4页ORTHOPAEDICS

摘　　要：目的术后水肿期(一般为术后2~6 d)的疼痛会严重影响病人康复,通过比较腰椎间盘突出症病人是否行术中神经根局部应用曲安奈德治疗的术后疼痛情况,评估术中局部应用曲安奈德对减轻术后早期神经根水肿反应性疼痛的疗效。方法回顾性研究2010年9月至2015年9月我院收治的腰椎间盘突出症病人185例,男99例,女86例,年龄为16~67岁,平均为(41.5±11.2)岁。根据手术情况分为:术中神经节应用曲安奈德组96例(给药组)和未使用曲安奈德89例(对照组)。两组病例一般资料比较,差异均无统计学意义(均P>0.05)。在行腰椎间盘髓核摘除术结束后缝合伤口前,在给药组病人神经根周围放入含有曲安奈德的明胶海绵;对照组则放入不含任何药物的明胶海绵。对比两组发生神经根水肿反应的发生率。记录和比较其中发生神经根水肿反应的病人术前,术后即刻、6 h、12 h和1~12 d时腰臀部以及手术侧下肢的疼痛视觉模拟量表(visual analogue scale,VAS)评分。结果两组病例术后神经根功能在术后即刻均获得良好的恢复。两组在水肿期均有不同程度地发生神经痛,给药组疼痛率为36.5%,低于对照组的57.3%(P<0.05)。两组中发生神经根水肿反应的病人比较,给药组水肿期VAS评分均低于对照组,差异有统计学意义(P<0.05);水肿期发生前后,两组均较术前达到良好改善水平,且两组的VAS评分差异无统计学意义(P>0.05)。结论腰椎间盘髓核摘除术中神经根周围局部应用含曲安奈德的明胶海绵,操作简单、安全,能有效地减少腰椎间盘突出症术后早期神经根水肿反应性疼痛的发生率、减轻疼痛的程度。Objective Early postoperative edema reaction of lumbar intervertebral disc herniation(LIDH)can seriously affect patients’recovery.We evaluated the effects of triamcinolone acetonide administration around nerve root during surgery.Methods There were185patients suffered from LIDH September2010to September2015.All patients were randomly divided into two groups.Ninety-six cases(experimental group)were treated with triamcinolone acetonide gelfoam around nerve root during surgery.Eighty-nine cases wereonly treated with gelfoam.There was no statistically significant difference in two groups’data.We recorded theVAS score of lower back and leg pain,and incidence rate of early postoperative edema reaction.Results Painin both two groups immediately relieved postoperatively.The incidence of recurrent pain caused by earlypostoperative edema reaction was36.5%in experimental group,which was lower than that in control group(57.3%).VAS score of recurrent pain caused by early postoperative edema reaction in experimental group was significantly lower than in control group(P<0.05).The patients recovered well out of edema period,and there was no significant difference in the VAS scores between two groups(P>0.05for all).Conclusion The application of triamcinolone acetonide around nerve root during surgery is easy to operate.Triamcinolone acetonide can effectively reduce the incidence of recurrent pain and alleviate pain caused by early postoperative edema reaction of LIDH.

关 键 词：腰椎 椎间盘移位 手术后并发症 神经根疼痛 早期水肿反应 曲安奈德 

分 类 号：R687.3[医药卫生—骨科学]