选择性神经根阻滞辅助定位在多节段腰椎退行性疾病治疗中的应用  

Application and effects of identifiyng culprit segment by selective nerve root blocking in treatment of multiple segmental degenerative lumbar disease

作　　者：刘浩[1] 童卫华[1] 周显平 李祖国[1] 陈国军[1] 夏寅 郭彩群 Liu Hao;Tong Weihua;Zhou Xianping;Li Zuguo;Chen Guojun;Xia Yin;Guo Caiqun(Department of Orthopedics, The 171th Hospital of PLA, Jiujiang 332000, China)

机构地区：[1]中国人民解放军第一七一医院骨科,九江332000

出　　处：《骨科临床与研究杂志》2021年第1期41-44,共4页Journal Of Clinical Orthopedics And Research

摘　　要：目的探讨选择性神经根阻滞术在多节段腰椎退行性疾病中的定位诊断作用及临床疗效。方法对2016年1月至2018年12月中国人民解放军第一七一医院骨科收治的因不能准确定位而行选择性神经根阻滞的多节段腰椎退行性疾病患者27例的临床资料进行回顾性分析。男15例,女12例;年龄(68.7±5.1)(55~78)岁。多节段腰椎间盘突出症8例,多节段腰椎管狭窄症7例,多节段腰椎间盘突出合并椎管狭窄症12例。对所有患者均行选择性神经根阻滞术确定责任间隙后采取不同手术方式治疗经皮侧路椎间孔镜手术13例,经皮后路椎间孔镜手术4例,微创经椎间孔入路腰椎椎体间融合术(TLIF)7例,开放TLIF 3例。记录术前、术后3 d、术后3个月及末次随访时的疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)并进行比较。采用SPSS 22.0软件对数据进行统计学分析。结果27例患者均获得随访,随访(28.1±5.1)(17~36)个月。VAS评分术后3 d、术后3个月和末次随访分别为3.4±1.1、3.1±1.2和2.3±1.1,与术前6.2±1.8相比差异均有统计学意义(P=0.03,0.02,0.02);ODI评分术后3 d、术后3个月和末次随访分别为28.1±11.2、20.5±9.7和16.7±5.2,与术前69.6±17.9相比差异均有统计学意义(P=0.02,0.02,0.01)。结论对于术前难以准确定位的腰椎多节段退行性疾病患者,选择性神经根阻滞是一种简单有效的确定责任间隙的方法。Objective To investigate the application and effects of identifying culprit segment by selective nerve root blocking in treatment of multiple segmental degenerative lumbar disease.Methods Data of 27 cases of multiple segmental degenerative lumbar disease treated using selective nerve root block assisted localization diagnosis in Department of Orthopedics,the 171th Hospital of PLA between January 2016 and December 2018 were analyzed retrospectively.Fifteen males and 12 females aged(68.7±5.1)(55-78)were included.There were 8 patients with multiple segmental lumbar disc herniation,7 patients with multiple segmental lumbar stenosis and 12 patients with multiple segmental lumbar disc herniation combined with lumbar stenosis.Percutaneous endoscopic lumbar discectomy(PELD),percutaneous endoscopic interlaminar discectomy(PEID),minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)and open TLIF were conducted in 13,7,4,3 cases,respectively.Visual analogue scale(VAS)of pain and Oswestry disability index(ODI)were used to evaluate the clinical results.Software of SPSS 22.0 was used to perform statistical analysis of the data.Results All the 27 patients were followed up for(28.1+5.1)(17-36)months.Compared with the preoperative scores,the VAS and ODI were significantly improved at 3 d postoperatively,3 months postoperatively and the latest follow-up(P=0.03,0.02,0.02 and 0.02,0.02,0.01,respectively).Conclusion Selective nerve root block is an effective and accurate way to identify the culprit segment for patients with multiple segmental degenerative lumbar disease whose location is not clear.

关 键 词：神经传导阻滞 脊神经根 诊断 椎间盘移位 椎管狭窄 

分 类 号：R68[医药卫生—骨科学]