CT引导硬膜外皮质激素注射治疗神经根型颈椎病

CT-guided cervical interlaminar epidural steroid injection for cervical radiculopathy

目的评价CT引导硬膜外皮质激素注射治疗神经根型颈椎病的安全性和疗效。方法回顾性分析2006年12月至2008年6月间一组32例保守治疗2周无效的神经根型颈椎病患者行CT引导下皮质激素注射治疗的临床及影像学资料。以视觉模拟评分(VAS)和Odom标准评估其治疗前后的症状。结果32例术后3个月Odom有效率达87.5%(28/32),VAS评分平均缓解5.88±1.10。其中突出组与退变组间、病程大于半年组与小于半年组间、治疗1次组与重复治疗2次组间有效率和VAS评分差异均无统计学意义(P>0.05)。结论CT引导下细针穿刺硬膜外"靶点"注射非颗粒型皮质激素是治疗神经根型颈椎病的理想选择,适合在保守治疗无效的患者中应用。

Objective To evaluate the safety and effectiveness of CT-guided cervical interlaminar epidural steroid injection for the treatment of cervical radiculopathy. Methods CT-guided cervical interlaminar epidural steroid injection was performed in 32 patients with cervical radioculopathy, encountered during the period of Dec. 2006 to June 2008, as the patients failed to respond to the conservative treatment in 2 weeks. The clinical data and the imaging findings were retrospectively analyzed. Before and after the procedure, visual analogue scale （VAS） and Odom criteria were used to evaluate the pain of the patient. Results Three months after the injection, improvement judged by Odom criteria was seen in 28 patients （87.5%）, and the mean pain relief value of VAS was 5.88±1.10. No significant difference in effective rate and in VAS score （P 〉 0.05） was found between protrusion group and degenerative group, between the group with the course over 6 months and the group with the course below 6 months, also between the group receiving one injection and the group receiving the second injection. Conclusion CT-guided fine needle （23 gauge） puncture epidural steroid （Decadron） ＂target spot＂ injection is an ideal alternative for the treatment of cervical radiculopathy, especially for the patients who fails to respond to the conservative treatment. （J Intervent Radiol, 2009, 18： 128-131）