DSA引导下腰脊神经后支松解治疗老年患者小关节源性腰痛的临床研究  

Clinical Observation of DSA-guided Neurolysis of Posterior Ramus of Lumbar Spinal Nerve on Old Patients with Facet-joint-related Lumbar Pain

作　　者：冯丹[1] 李少军 袁峰[1] 张书力[1] 胡焓[1] 乔杰[1] Feng Dan;Li Shaojun;Yuan Feng(Department of Pain Management,Wuhan No.1 Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院疼痛科

出　　处：《华中科技大学学报（医学版）》2019年第4期446-449,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：武汉市卫生计生委科研项目(No.WX17D04)

摘　　要：目的观察在数字减影血管造影技术(digital subtraction angiography,DSA)引导下腰脊神经后支松解治疗老年患者小关节源性腰痛的疗效及安全性。方法分析2016年7月至2018年7月在武汉市第一医院疼痛科治疗的148例腰椎小关节源性疼痛患者的临床资料。所纳入研究患者随机分为两组,松解组(n=76)和药物组(n=72)。松解组在DSA引导下采用一次性硬膜外穿刺包中硬膜外穿刺针钝性分离腰脊神经后支。药物组患者采用口服消炎镇痛药物治疗。采用视觉模拟评分法(visual analogue scores,VAS)、腰椎功能障碍问卷(Roland-Morris questionnaire,RMQ)及Oswestry功能障碍指数(Oswestry disability index,ODI)评估治疗前及治疗后1、6个月时患者疼痛评分和患者腰椎功能评分。结果本研究首次报道DSA引导下腰脊神经后支松解治疗老年患者小关节源性腰痛。在治疗1个月及6个月时,松解组患者VAS得分明显低于药物组患者,差异有统计学意义[(3.4±1.1)vs.(4.0±1.3),P=0.013;(2.9±1.1)vs.(4.1±1.3),P<0.001]。同样,在治疗1个月及6个月时,松解组患者的RMQ得分、ODI得分明显低于药物组,差异有统计学意义(均P<0.05)。松解组76例患者无麻木及感染等并发症。结论 DSA引导下腰脊神经后支松解治疗可有效缓解老年患者腰椎小关节源性的腰痛症状和改善患者腰部功能状况,且操作安全,无不良反应,值得推广。Objective To investigate the safety and efficacy of digital subtraction angiography(DSA)-guided neurolysis of posterior ramus of lumbar spinal nerve on old patients with facet-joint-related lumbar pain.Methods A total of 148 patients with chronic low back pain were enrolled in this study from July 2016 to July 2018,in Wuhan No.1 Hospital.All the patients were randomly divided into 2 groups:neurolysis group(n=76)and drug group(n=72).In the neurolysis group,an epidural needle in disposable epidural anaesthesia puncture kit under DSA was used for neurolysis of posterior rami of lumbar spinal nerve.In drug group,patients received the conservative treatment of oral non-steroidal anti-inflammatory drugs(NSAIDs).Visual analogue scores(VAS),Roland-Morris Questionnaire(RMQ)and Oswestry disability Index(ODI)were used to assess pain control and lumbar function before therapy,and at 1 month and 6 months after treatment.Results This was the first report about the DSA-guided neurolysis of posterior ramus of lumbar spinal nerve in old patients with facet-joint-related lumbar pain.VAS in the neurolysis group was significantly lower than that in the drug group at 1 month and 6 months after the treatment[(3.4±1.1)vs.(4.0±1.3),P=0.013;(2.9±1.1)vs.(4.1±1.3),P<0.001].Similarly,RMQ score and ODI score in release group were significantly lower than those in the drug group(all P<0.05).No patients in the neurolysis group had numbness and infection in the innervation area of the treated nerves.Conclusion DSA-guided neurolysis of posterior ramus of lumbar spinal nerve can effectively relieve pain symptoms and improve lumbar function in old patients with facet-joint-related lumbar pain.Additionally,this treatment is safe and has no side effects,thus deserving promoting.

关 键 词：腰椎小关节 脊神经后支 神经松解治疗 腰椎功能 

分 类 号：R323.4[医药卫生—人体解剖和组织胚胎学]