硬膜外侧隐窝注射治疗腰椎间盘突出症的临床观察

Treatment of lumbar vertebra disc protrusion by injection of lateral epidural recess

目的观察硬膜外侧隐窝注射消炎镇痛药物治疗腰椎间盘突出症的临床效果。方法A 组为硬膜外倒隐窝注射治疗组,借助等比例正位腰椎X线片确定进针位置,按腰椎CT片确定进针深度, L4-5及以上腰椎间盘突出症者行椎板外切迹穿刺法,L5-S1者行小关节内缘垂直进针穿刺法。B组采用常规硬膜外后正中穿刺法。两组均注入2%利多卡因5 ml,维生索B12 1000μg,维生素B1 100mg和曲安奈德40mg,每周1次,4次为1个疗程。结果A组32例治愈率81.25%,B组30例治愈率63.33%,且A组患者创伤小无明显并发症。结论硬膜外侧隐窝穿刺注射消炎镇痛药治疗腰椎间盘突出症的效果比常规硬膜外穿刺治疗好。

Objective To observe the clinical effect of injecting anti-inflammatory analgesic solution into lateral epidural recess on protrusion of vertebral disc. Methods In group A (lateral epidural recess) the puncture point was determined by lumbar vertebral roentgenogram of equal proportion and the depth of puncture by lumbar vertebral CT. The vertebral disc protrusion in L4-5 and above were punctured via the outer notch of vertebral laminae, and was punctured in L5--S1 vertically via the inner side of the small joint. Group B was punctured via routine posterior middle approach. Both groups were injected with 2% lidocaine 5 ml,VitB12 1 000μg, VitB1 100mg and triamcinolone acetoneide 40mg in total of 10ml, once a week and four times as a course of treatment. Results The cure rate in group A was 81.25% in 32 patients and in group B 63.33% in 30 patients and the complications in group A were less than that in group B. Conclusion Treatment of lumbar vertebra disc protrusion through epidural lateral recess is better than through posterior middle approache. This method is safe and dependable, with less risk of puncturing into subarachnoid space.