改良旁正中入路与椎间孔入路腰段硬膜外腔注射类固醇药物的扩散程度与临床疗效对比  

Comparison of drug diffusion extent and clinical effect of steroid injection in lumbar epidural space by modified paramedianinterlaminar approach with transforaminal approach

作　　者：黄韶鹏[1] 袁月 邓超[1] 刘金锋[1] Huang Shaopeng;Yuan Yue;Deng Chao;Liu Jinfeng(Department of Pain,the Second Affiliated Hospital of Harbin Medical University,Heilongjiang Province Key Lab of Research on Anesthe-siology and Critical Care Medicine,Harbin 150001,China;Department of Anesthesiology,the Second Hospital of Harbin,Harbin 150056,China)

机构地区：[1]哈尔滨医科大学附属第二医院疼痛科,黑龙江省麻醉与危重病重点实验室,150001 [2]哈尔滨市第二医院麻醉科,150056

出　　处：《国际麻醉学与复苏杂志》2021年第8期840-844,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的比较改良旁正中入路(modified paramedian interlaminar,mPI)与椎间孔入路(transforaminal,TF)在腰段硬膜外腔注射类固醇药物时药物扩散程度与临床疗效。方法将64例确诊为腰椎间盘突出症的患者根据不同进针路径分为改良旁正中入路组(mPI组)和椎间孔入路组(TF组),每组各32例。穿刺至硬膜外腔后两组患者均给予2 ml造影剂,观察造影剂在硬膜外腔及神经根处分布情况,随即两组均给予复方倍他米松注射液(1 ml)与生理盐水混合液共2 ml。操作中观察两组造影剂在硬膜外腔前间隙分布情况、患者造影剂入血情况及出现神经刺激症状的情况,记录两组患者治疗前及治疗后3个月时的疼痛数字评分(Numeric Rating Scale,NRS)和5点利克特量表(5⁃Point Likert Scale,Likert)评分,比较两组患者治疗后3个月的治疗有效率。结果mPI组造影剂扩散至硬膜外腔前间隙的程度(2级与3级总和)高于TF组(P<0.05),造影剂扩散等级为3级的例数多于TF组(P<0.05)。mPI组的造影剂入血和患者出现神经刺激症状的比例低于TF组(P<0.05)。两组患者治疗后3个月NRS、Likert评分及治疗有效率差异无统计学意义(P<0.05)。结论在两组疗效相同的基础上,mPI入路能更加具有针对性、安全地将药物注射至硬膜外腔前间隙。Objective To compared the drug diffusion and clinical effect of modified paramedian interlaminar(mPI)approach with transforaminal(TF)approach for steroid injection in the lumbar epidural space.Methods The 64 patients diagnosed with lum⁃bar disc herniation,were divided into mPI group and TF group according to different needle paths,32 patients in each group.After puncture to the epidural space,two groups of patients were given 2 ml contrast agents and were observed contrast agents distribution in the epidural space and nerve root.Then,two groups were given 2 ml mixture of compound betamethasone injection 1ml and normal sa⁃line.The distribution of contrast agent in the anterior epidural space,the vascular uptake and the nerve irritation of the patients in the operation were observed.Record the Numeric Rating Scale(NRS)and 5⁃Point Likert Scale(Likert)between the two groups at the time points of before,3 month after treatment and the effective rate of 3 months after treatment was compared between the two groups.Re⁃sults In mPI group,the diffusion level of contrast agent in anterior epidural space(level 2 and 3)was greater than that in TF group(P<0.05).Cases of contrast agent diffusion grade 3 was greater than that of TF group(P<0.05).The cases of vascular up take of contrast agents and nerve irritation in the mPI group were lower than those values in the TF group(P<0.05).There was no statistical significance in NRS,Likert score and effective rate between two groups 3 months after treatment(P<0.05).Conclusions On the basis of the same clinical effect of the two groups,the mPI approach is more effective and safer for transfer drugs into the anterior epidural space than the TF approach.

关 键 词：硬膜外腔 造影剂 腰椎间盘突出症 改良旁正中入路 椎间孔入路 

分 类 号：R687.3[医药卫生—骨科学]