超声引导下侧入路颈脊神经后支三氧联合注射松解治疗颈脊神经后支源性慢性颈肩痛  

Clinical study of ultrasound-guided trioxygen injection of posterior branch of cervical spinal nerve via the lateral approach on the treatment of chronic neck and shoulder pain caused by posterior branch of cervical spinal nerve

作　　者：王玥[1] 陈辉[1] 岑奕 张哲[1] 张欣[1] 李宗锡 陈珍珍 贾彤彤 章美玲 Wang Yue;Chen Hui;Cen Yi;Zhang Zhe;Zhang Xin;Li Zongxi;Chen Zhenzhen;Jia Tongtong;Zhang(Meiling Department of Pain Medicine,Shanghai Fourth People's Hospital Affiliated to Tongji University,Shanghai 200434,China)

机构地区：[1]同济大学附属上海市第四人民医院疼痛科,上海200434

出　　处：《临床荟萃》2023年第8期714-718,共5页Clinical Focus

基　　金：上海市虹口区卫生健康委员会科研课题超声引导下颈脊神经后支松解治疗劳损性颈肩痛的解剖基础与临床应用(虹卫1902-12)。

摘　　要：目的探讨超声引导下侧入路法行颈脊神经后支三氧联合注射松解治疗颈脊神经后支源性慢性颈肩痛的临床安全性及有效性。方法选取2020年10月至2021年10月上海市第四人民医院疼痛科收治的颈脊神经后支源性慢性颈肩痛患者102例。纳入患者被随机分两组,A组(n=51)应用超声平面外引导技术,以C3、C4、C5脊神经后支为穿刺靶点,行医用三氧(20μg/ml)各点5 ml分离C3、C4、C5脊神经后支,并注射消炎镇痛液(倍他米松1 mg+利多卡因40 mg,以盐水稀释至12 ml,各点2 ml)。B组(n=51)单纯采用C3、C4、C5脊神经后支注射消炎镇痛液(药物同A组)。记录患者治疗前,治疗完成后1周、1个月、3个月和6个月的疼痛评分(NRS)、匹兹堡睡眠质量指数(PSQI)和头颈部活动度评分(ROM)、并发症发生情况,计算治疗有效率,评估患者对治疗的满意度。结果与治疗前比较,两组治疗后1周、1个月、3个月以及6个月的NRS、PSQI、ROM评分差异有统计学意义(P<0.05);组间比较,两组治疗后1周的NRS、PSQI、ROM评分差异无统计学意义(P>0.05);组间比较,两组治疗后1个月、3个月以及6个月的NRS、PSQI、ROM评分差异有统计学意义(P<0.05)。治疗后6个月,A组满意率为75%,B组满意率为55%,组间比较差异有统计学意义(P<0.05)。两组术后即时及术后3d均未出现局部血肿、感染、区域麻木等并发症。结论超声引导侧入路法颈脊神经后支三氧注射松解治疗可长期改善颈脊神经后支源性慢性颈肩痛患者症状,穿刺路径安全,治疗效果确切,是一种有效的治疗手段。Objective To investigate the clinical safety and efficacy of ultrasound-guided trioxygen injection of posterior branch of cervical spinal nerve via the lateral approach on the treatment of chronic neck and shoulder pain caused by posterior branch of cervical spinal nerve.Methods A total of 102 patients with chronic neck and shoulder pain caused by posterior branch of cervical spinal nerve admitted to the Department of Pain Medicine,Shanghai Fourth People's Hospital from October 2020 to October 2021 were selected.The patients were randomly divided into group A and B,with 51 cases per group.Using the out-of-plane ultrasound guidance technique,and C3,C4 and C5 posterior branch of spinal nerve as puncture sites,5 ml of trioxygen(20μg/ml)was administrated to separate C3,C4 and C5 posterior branch of spinal nerve in patients of group A,and anti-inflammatory and analgesic solutions(betamethasone 1 mg+lidocaine 40 mg,diluted to 12 ml with saline,2 ml at each point)were injected.Patients in group B were administrated with Xiaoyan Zhentong Liquid into the posterior branch of C3,C4 and C5 spinal nerves alone(the drugs were the same as group A).The pain assessed by the Numerical Rating Scale(NRS),the Pittsburgh Sleep Quality Index(PSQI),head and neck range of motion score(ROM)and complications before treatment and at 1 week,1 month,3 months and 6 months after treatment were recorded.Treatment response rate and patient satisfaction with the treatment were recorded as well.Results Compared with those before treatment,there were significant differences in the NRS,PSQI,and ROM scores at 1 week,1 month,3 months,and 6 months after treatment between the two groups(P<0.05).There were no significant differences in the NRS,PSQI,and ROM scores at 1 week after treatment between the two groups(P>0.05).There were significant differences in NRS,PSQI,and ROM scores at 1 month,3 months,and 6 months after treatment between the two groups(P<0.05).Six months after treatment,the patient satisfaction rate was significantly higher in group A than

关 键 词：慢性颈肩痛 颈脊神经后支 医用三氧 松解 疼痛治疗 

分 类 号：R441.1[医药卫生—诊断学]