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[1]宋卿鵬,田偉,何達,等.超聲及電刺激引導(dǎo)下神經(jīng)根封閉治療腰椎退行性疾病導(dǎo)致的下肢放射痛[J].中醫(yī)正骨,2018,30(06):44-46.
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超聲及電刺激引導(dǎo)下神經(jīng)根封閉治療腰椎退行性疾病導(dǎo)致的下肢放射痛()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第30卷
期數(shù):
2018年06期
頁碼:
44-46
欄目:
臨床報道
出版日期:
2018-06-20

文章信息/Info

作者:
宋卿鵬; 田偉; 何達; 周雁; 王晉超; 李祖昌; 馮嘯
北京積水潭醫(yī)院,北京 100035
關(guān)鍵詞:
腰椎;  放射痛;  下肢;  超聲檢查;  電刺激;  封閉療法;  脊神經(jīng)根
文獻標(biāo)志碼:
A
摘要:
目的:探討超聲及電刺激引導(dǎo)下神經(jīng)根封閉治療腰椎退行性疾病導(dǎo)致下肢放射痛的臨床療效和安全性。方法:2015年11月至2016年6月收治腰椎退行性疾病導(dǎo)致的下肢放射痛患者129例。男55例,女74例; 年齡(52.47±15.17)歲; 椎間盤突出87例,椎管狹窄28例,椎體滑脫7例,脊柱側(cè)彎7例; 左側(cè)下肢放射痛62例,右側(cè)下肢放射痛67例。所有患者均經(jīng)影像學(xué)檢查確認存在神經(jīng)根受壓,下肢放射痛持續(xù)8周以上,經(jīng)休息、理療、非甾體類抗炎藥及肌肉松弛藥物治療后均無明顯改善。均無麻醉藥物過敏史及腰椎、骶椎手術(shù)史,未合并馬尾綜合征、下肢肌力減退、凝血功能障礙及其他周圍神經(jīng)病變。均采用超聲及電刺激引導(dǎo)下神經(jīng)根封閉治療。神經(jīng)根封閉操作結(jié)束30 min后,采用視覺模擬量表(visual analogue scale,VAS)評定下肢疼痛程度,VAS評分較治療前減少<50%則認為治療節(jié)段為非責(zé)任節(jié)段,2 h后在其他節(jié)段再次行神經(jīng)根封閉操作,并再次以VAS評定下肢疼痛程度。治療后3 d,再次評定VAS評分。觀察治療后1年內(nèi)患者接受手術(shù)治療的情況及治療和隨訪期間的并發(fā)癥發(fā)生情況。結(jié)果:所有患者均順利完成治療,未發(fā)生硬膜穿孔、硬膜外血腫、神經(jīng)損傷等嚴重并發(fā)癥。L5神經(jīng)根受壓74例,S1神經(jīng)根受壓30例,L4神經(jīng)根受壓21例,L3神經(jīng)根受壓3例,L2神經(jīng)根受壓1例。中央管區(qū)壓迫32例,外側(cè)區(qū)域(椎間關(guān)節(jié)下區(qū)域、椎間孔區(qū)域、椎間孔外區(qū)域)壓迫97例。治療前下肢疼痛VAS評分為(7.58±0.61)分; 治療后30 min,VAS評分為(0.89±1.05)分; 治療后3 d,94例疼痛明顯緩解(VAS評分較治療前減少≥50%),VAS評分為(3.18±0.62)分,35例患者疼痛緩解不明顯(VAS評分較治療前減少<50%),VAS評分為(4.60±0.50)分。治療后1年內(nèi),60例患者接受手術(shù)治療(經(jīng)椎間孔椎體間融合術(shù)或經(jīng)皮椎間孔鏡椎間盤切除術(shù)),其中治療后3 d疼痛明顯緩解者34例(34/94,36.17%)、治療后3 d疼痛緩解不明顯者26例(26/35,74.29%),椎間盤突出者34例(34/87,39.08%)、椎管狹窄者17例(17/28,60.71%)、椎體滑脫者5例(5/7,71.43%)、脊柱側(cè)彎者4例(4/7,57.14%)。結(jié)論:超聲及電刺激引導(dǎo)下神經(jīng)根封閉是治療腰椎退行性疾病導(dǎo)致下肢放射痛的一種安全有效方式,椎間盤突出導(dǎo)致的下肢放射痛及神經(jīng)根封閉后短期內(nèi)止痛效果好的患者預(yù)后較好。

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更新日期/Last Update: 2018-10-30