臭氧髓核溶解术联合窦椎神经阻滞治疗颈椎间盘源性疼痛的临床疗效  

Effect of cervical disc ozone nucleolysis combined with sinus vertebral nerve block for the treatment of patients with cervical discogenic pain

作　　者：左正敏 郭娅 吴婷 李祥勇 刘堂华 Zuo Zhengmin;Guo Ya;Wu Ting;Li Xiangyong;Liu Tanghua(Department of Painology,Shougangshuigang General Hospital,Liupanshui City,Guizhou Province 553000,China;Department of Painology,the Third People's Hospital of Yibin City,Yibin City,Sichuan Province 644000,China)

机构地区：[1]六盘水市首钢水钢总医院疼痛科,贵州省六盘水市553000 [2]宜宾市第三人民医院疼痛科(李庄),四川省宜宾市644000

出　　处：《中华疼痛学杂志》2021年第5期491-495,共5页Chinese Journal Of Painology

摘　　要：目的观察颈椎间盘臭氧髓核溶解术联合窦椎神经阻滞治疗颈椎间盘源性疼痛的临床疗效。方法对2019年1月至2021年1月在六盘水市首钢水钢总医院疼痛科住院明确诊断为颈椎间盘源性疼痛并排除禁忌证的216例患者,用随机数字表法随机分为臭氧溶核组(n=103),行颈椎间盘臭氧髓核溶解术;联合阻滞组(n=113),行颈椎间盘臭氧髓核溶解术联合窦椎神经阻滞治疗。首先对病变椎间盘施行椎间盘造影,明确病变椎间盘后开始注射臭氧,首次注射臭氧2 ml时观察复制疼痛反应情况。联合阻滞组在常规椎间盘臭氧髓核溶解术结束后,针尖继续穿刺到椎间隙后缘,进行窦椎神经阻滞。两组治疗结束后,分别记录治疗前及治疗后随访7 d、1和6个月时的视觉模拟评分(VAS),并行VAS加权值处理以评价各时点的疗效。结果联合阻滞组失访4例,臭氧溶核组失访2例。与治疗前比较,两组患者治疗后各时点VAS评分均降低,且差异均有统计学意义(P均<0.05);与臭氧溶核组比较,联合阻滞组治疗后各时点VAS评分均较低,且差异均有统计学意义(P均<0.05)。联合阻滞组在治疗后7 d、1个月、6个月时的优良率分别为80.7%(88/109例)、81.6%(89/109例)、88.1%(96/109例),均高于臭氧溶核组治疗后各时点的优良率55.4%(56/101例)、60.4%(61/101例)、66.3%(67/101例),差异均有统计学意义(P均<0.05)。臭氧溶核组术后6个月时的优良率[66.3%(67/101例)]、总有效率[74.2%(75/101例)]明显高于治疗后7 d时的优良率[55.4%(56/101例)]、总有效率[59.4%(60/101例)]。联合阻滞组内治疗后各时点优良率、总有效率差异无统计学意义(P均>0.05)。结论颈椎间盘臭氧髓核溶解术联合窦椎神经阻滞治疗颈椎间盘源性疼痛的临床疗效优于单纯颈椎间盘臭氧髓核溶解术。Objective To observe the clinical effect of cervical disc ozone nucleolysis combined with sinus vertebral nerve block in the treatment of cervical discogenic pain.Methods Two hundred and sixteen patients with definite diagnosis of cervical discgenic pain and ruling out the contraindications in Department of Painology,Liupanshui City Shougangshuigang General Hospital from January 2019 to January 2021 were collected and randomly divided into two groups by random number table method:cervical disc ozone nucleolysis group(n=103)and combined with nerve block group(NB group,n=113).The patients were treated with cervical disc ozone nucleolysis in the cervical disc ozone nucleolysis group,and treated with sinus vertebral nerve block in addition to the method of cervical disc ozone nucleolysis group in NB group.During the operation,the diseased disc was firstly discography,and the replicated pain reaction was observed.Visual analogue scale(VAS)was recorded before treatment,and 7 days after treatment,1 month and 6 months after discharge,and then VAS weighted value was used to evaluate the efficacy at each time point.Results Four patients in the NB group and two patients in the cervical disc ozone nucleolysis group were lost to follow-up.Compared with pretreatment,VAS decreased at each time point after treatment in the two groups,with statistical significance(all P<0.05);VAS was much lower at each time point after treatment in the NB group than that in the cervical disc ozone nucleolysis group,with statistical significance(all P<0.05).The excellent and good rate was 80.7%(88/109 cases),81.6%(89/109 cases)and 88.1%(96/109 cases)in the NB group at 7 d,1 month and 6 months after the treatment respectively,which was higher than 55.4%(56/101 cases),60.4%(61/101 cases)and 66.3%(67/101 cases)in the cervical disc ozone nucleolysis group respectively,with statistically significant(all P<0.05).The excellent and good rate[66.3%(67/101 cases)]and total effective rate[74.2%(75/101 cases)]at 6 months were significantly higher than the exc

关 键 词：颈椎间盘源性疼痛 颈椎间盘臭氧髓核溶解术 颈椎间盘窦椎神经阻滞 

分 类 号：R687.3[医药卫生—骨科学]