硬膜外腔侧隐窝穿刺的研究

Study of the puncture approches to epidurai lateral recess

目的:设计一种新进路,使消炎镇痛液更集中地作用于病变神经根,或将胶原酶直接注射到突出的椎间盘处而摆脱大型X线杋的限制,更简便有效地治疗腰腿痛。方法:通过解剖学研究、腰椎X线摄片和CT摄片分析,设计出经椎板外切迹或小关节内缘进路到达硬膜外腔侧隐窝并将其应用于临床。根据感觉平面的测定、疗效的评定和部分病例穿刺过程中的CT扫描观察,确认该进路的安全性和可行性。结果:应用椎板外切迹进路行硬膜外腔侧隐窝穿刺170例,成功168例,失败2例,穿刺成功率为98.82%;应用小关节内缘进路15例,全部成功。结论:经椎板外切迹或小关节内缘进路,可准确地到达硬膜外腔侧隐窝,更有效地发挥治疗作用。该进路应用于溶盘术可免除大型X线机的限制,避免X线对医患双方的损伤。

The new approaches were designed to have anti-inflammatory analgetics act concentratively on the surrounding of pathological nerve roots or to inject collagenase directly to the protruding lumbar intervertebral disc for more simple and effective treatment of the low back pain. Method: The approaches to epidural lateral recess via incisura margo lateralis of lamina arcus vertebrae or margo medialis of joint processus artieularis were supposed and applied in clinic after study of anatomy and analysis of lumbar vertebra X-ray and CT photographes. The safety and feasibility of the approaches were evaluated according to the test of block region, measurement of therapeutic effect and monitoring of CT during the whole procedures in some cases. Result: A total of 170 cases via the incisura margo lateralis of lamina areus vertebrae were tested, 168 cases turned out to be successful and 2 cases failing. Another 15 cases via margo medialis of joint proeessus articularis, all punctures were successful. Conclusion: The approaches can lead to epidural lateral recess precisely to obtain a better treatment. When the technique is applied to discolysis, no X-ray machine will be needed and therefore no injury of X-ray occurs to both doctors and patients.