X线片引导腰脊神经后内侧支阻滞治疗腰椎小关节综合征

X-RAY FILM-GUIDED BRANCH OF MEDIAL POSTERIOR LUMBAR RAMUS BLOCK IN THE TREATMENT OF LUMBAR FACET SYNDROME BLOCK

目的:观察X线片引导腰脊神经后内侧支阻滞治疗腰椎小关节综合征的有效性。方法:60例临床诊断腰椎小关节综合征的患者,随机均分为治疗组(B组,n=30)和对照组(C组,n=30)。以相应上关节突与横突根部交界处为靶点,在X线片测量引导下行双侧腰脊神经后内侧支阻滞。用药分别为1%盐酸利多卡因(内含复方倍他米松注射液1ml+甲钴铵注射液500μg)和1%盐酸利多卡因。评价患者阻滞前、阻滞后5 min、1周、2周和4周时的VAS评分和腰椎活动度,记录阻滞中和阻滞后的并发症。结果:两组患者阻滞前VAS评分无显著差异,阻滞后5 min时的VAS评分均明显低于阻滞前基础值(P<0.05),腰椎活动度明显高于阻滞前基础值(P<0.05)。C组阻滞后1周、2周和4周时的VAS评分和腰椎活动度与阻滞前无明显差异(P>0.05),B组VAS评分仍明显低于阻滞前基础值(P<0.05),腰椎活动度明显高于阻滞前基础值(P<0.05)。B组阻滞后5min时的VAS评分和腰椎活动度与C组相近,但阻滞后1周、2周和4周时的VAS评分明显低于C组(P<0.05),腰椎活动度明显高于C组(P<0.05)。两组患者均未发生并发症。结论:在门诊缺少X线透视设备的情况下,X线片引导腰脊神经后内侧支阻滞是治疗腰椎小关节综合征的有效方法。

Objective： To observe the effect of X-ray film-guided block of medial branch of posterior lumbar ramus in the treatment of lumbar facet syndrome.Methods： 60 patients with clinical diagnosis of lumbar facet syndrome were randomly allocated to medial branch nerve block group（B,n=30） and control group（C,n=30）.The bilateral block of medial branch of posterior lumbar ramus under the guidance of lumbar X-ray film was performed in both groups using 1% lidocaine hydrochloride.The effect of the block was assessed by visual analogue scale（VAS） and lumbar activity at 5 min,1,2 and 4 week after block.The complications were also recorded.Results： The difference of pre-block VAS score between both groups was not significant（P0.05）.The VAS score was lower and back movement was greater significantly in both groups at 5 min after block than pre-block（P0.05）.The VAS score and back movement in group C at 1,2 and 4 weeks after block were similar with pre-block baseline value（P0.05）,but VAS score was lower and back movement was greater significantly in group B（P0.05）.Though there was no significant difference in VAS score and back movement at 5 min after block between both groups（P0.05）,the VAS score was lower and back movement was greater significantly in group B than that in group C（P0.05）.There was complication occurred in both groups.Conclusion： In