神经根封闭定位经皮椎间孔镜手术治疗腰椎退行性疾病的疗效

Application of nerve root blocks in percutaneous transforaminal endoscopic discectomy for degenerative lumbar disease

目的探讨神经根封闭定位经皮椎间孔镜手术治疗腰椎退行性疾病的疗效。方法选取2016-01至2019-03医院38例单侧症状的腰椎退行性疾病患者予以神经根封闭。其中,腰椎间盘突出19例,腰椎管狭窄11例,腰椎间盘突出合并腰椎管狭窄8例。对明确为单一责任节段的患者,施行经皮椎间孔镜减压手术。术前、术后2周及最后随访时均进行VAS评分及ODI评分。结果(1)神经根封闭情况:33例明确为单一责任节段的病变;2例明确为两个责任节段;3例没有出现症状缓解,不能明确责任节段,给予非甾体类抗炎药及理疗等治疗后症状缓解。(2)手术情况:33例明确为单一责任节段的患者,均采用经皮椎间孔镜减压手术,症状均在术后显著缓解,平均随访12个月。术后2周VAS评分与ODI指数均较术前明显降低,差异有统计学意义(P<0.05),且末次随访与术后2周的差异有统计学意义(P<0.05)。结论神经根封闭术可以明确退行性腰椎疾病患者的责任节段,并为经皮椎间孔镜手术节段的选择提供可靠依据,达到精准治疗和微创治疗的目的,疗效满意。

Objective To explore the therapeutic effect of nerve root blocks in percutaneous transforaminal endoscopic discectomy for degenerative lumbar disease.Methods From January 2015 to March 2019,the nerve root block technique was applied in 38 patients of degenerative lumbar disease with unilateral symptoms,including 19 cases of lumbar disc hernination(LDH),11 cases of lumbar spinal stenosis(LSS)and 8 cases of both.After never root blocking,patients with a positive single responsibility segment underwent trasnforaminal endoscopic discectomy.The clinical outcomes were evaluated with Visual Analogue Score(VAS)and Oswestry Disability Index(ODI).Results 1.The nerve root block:33 cases with clear responsibility segments were subjected to transforaminal endoscopic discectomy,2 cases were identified as having two responsibility segments and 3 cases had no clear responsibility segments.2.Surgery:the symptoms of patients after operation were significantly relieved.The VAS and ODI of patients were improved significantly two weeks after operation(P<0.05),especially during the last follow-up(P<0.05).Conclusions The nerve root block can be a more specific diagnostic method for patients with degenerative lumbar disease,provide reliable evidence for the selection of surgical segments for transforaminal endoscopic discectomy,and serve the purpose of precise and minimally invasive treatment.