超声引导下腰脊神经后内侧支三点阻滞法的应用研究  

Application of ultrasound guided three-sites block of posterior medial branch of lumbar spinal nerve

作　　者：杨小林[1] 吴宏伟[1] 沈爱云 任映梅 YANG Xiaolin;WU Hongwei;SHEN Aiyun;REN Yingmei(Department of Anesthesiology,Rugao People′s Hospital,Rugao,Jiangsu 226500,China)

机构地区：[1]江苏省如皋市人民医院麻醉科,226500

出　　处：《重庆医学》2021年第2期285-288,共4页Chongqing medicine

基　　金：南通市卫生健康委员会科研立项课题(MB2019045);南通市市级科技计划(指导性)项目(MSZ19142);如皋市科技计划项目(201943)。

摘　　要：目的观察在超声引导下行腰脊神经后内侧支三点阻滞法的临床效果。方法选择该院2018年3月至2019年12月诊断的150例非特异性下腰痛(NLBP)患者分为3组:超声引导下关节突关节(小关节)阻滞组(A组,n=50)、超声引导下腰脊神经后内侧支阻滞组(B组,n=50)、超声引导下关节突关节+腰脊神经后内侧支阻滞组(C组,n=50)。观察治疗前及治疗后1周、1个月和3个月视觉模拟评分法(VAS)评分、日本骨科协会(JOA)评分,并记录神经损伤、穿刺点感染、中毒反应、药物过敏、恶心呕吐等不良反应发生情况。结果与治疗前比较,治疗后1周3组VAS评分均明显降低(P<0.05),JOA评分均明显升高(P<0.05);治疗后1个月,B、C两组VAS评分均明显降低(P<0.05),JOA评分均明显升高(P<0.05);治疗后3个月C组VAS评分明显降低(P<0.05),JOA评分明显升高(P<0.05);3组不良反应发生率比较,差异无统计学意义(P>0.05)。结论超声引导下腰脊神经后内侧支三点阻滞法近期疗效满意且无明显不良反应。Objective To observe the clinical effect of three-sites block method of the posterior medial branch of lumbar spinal nerve under the guidance of ultrasound.Methods A total of 150 patients with nonspecific low back pain(NLBP)from March 2018 to December 2019 were randomly divided into 3 groups:the ultrasound guided facet joint block group(group A,n=50),the ultrasound guided posterior medial branch block of lumbar spinal nerve(group B,n=50),the ultrasound guided facet joint block+posterior medial branch block of lumbar spinal nerve group(group C,n=50).The visual analogue scale(VAS)score and Japanese Orthopedic Association(JOA)score were observed before treatment and 1 week,1,3 months after treatment,and adverse reactions such as nerve injury,infection of puncture site,toxic reactions,drug allergy,nausea and vomiting were recorded.Results Compared with that before treatment,on the first week after treatment,VAS score of the 3 groups all decreased(P<0.05)and JOA score all increased(P<0.05).On the first month after treatment,VAS score of groups B and C decreased(P<0.05)and JOA score increased(P<0.05).On the third month after treatment,VAS score of group C decreased(P<0.05)and JOA scores increased(P<0.05).There was no significant difference in rate of adverse reactions among the 3 groups(P>0.05).Conclusion Ultrasound guided three-sites block of the posterior medial branch of lumbar spinal nerve has a satisfactory short term effect with no obvious adverse reactions.

关 键 词：腰痛 超声引导 腰脊神经 神经阻滞 

分 类 号：R681.5[医药卫生—骨科学]