CT引导下经皮治疗腰椎间盘突出引起的坐骨神经根炎

CT Guided Percutaneous Treatment of Sciatic Neuritis due to Intervertebral Disc Hernia

目的： 对ＣＴ 引导下经皮治疗腰椎间盘突出引起的坐骨神经根炎（ｐｅｒｃｕｔａｎｅｏｕｓ ｔｒｅａｔｍｅｎｔ ｏｆ ｓｃｉａｔｉｃ ｎｅｕｒｉｔｉｓ ｄｕｅ ｔｏ ｉｎｔｅｒｖｅｒｔｅｂｒａｌｄｉｓｃｓ ｈｅｒｎｉａ ， ＰＴＳＮＤＨ） 的方法及疗效进行探讨。材料与方法： １９９３ 年３ 月～１９９７ 年１２ 月，ＣＴ 引导下ＰＴＳＮＤＨ ３０６ 例腰腿痛患者。临床表现均为腰痛及单侧下肢放射痛，ＣＴ 影像学证实为椎间盘突出。在ＣＴ 引导下用２０Ｇ 腰穿针穿至突出层面受炎性浸润的坐骨神经根周围，注射皮质类固醇至硬膜外间隙。结果： ３０６ 例均成功完成ＣＴ 引导下ＰＴＳＮＤＨ 操作，操作完成后住院观察１ 天。对１８６ 例进行治疗后１ ～２４ 个月的追踪随访，其中１６１ 例（８６ ．５ ％ ） 效果好，１６ 例（８ ．６ ％ ） 效果较好，９ 例（（４ ．８ ％ ） 效果较差。结论： ＣＴ 引导下ＰＴＳＮＤＨ 安全、准确、见效快、微创伤，符合椎间盘突出引起的坐骨神经根炎的病理机制，值得临床推广。

Objective: To investigate the technique and effectiveness of CT guided percutaneous treatment of sciatic neuritis due to intervertebral disc hernia (PTSNDH).Materials and Methods:PTSNDH was performed in 306 patients with back and leg pain during the period of March 1993～Dec.1997. All patients complained back pain and radiating pain in one leg. CT scan revealed intervertebral disc hernia. With CT guidance the lumbar puncture needle of 20G was advanced to the sites surrounding the inflamed sciatic nerve roots, and injection of corticosteroid into the subdural space was followed.Results:PTSNDH was successfully accomplished in all 306 patients and the patients were observed in the hospital for one day after the procedure. Follow up for 1～24 months was made in 186 cases, of which 161 (86.5%) were graded as good result, 16 (8.6%) fair result and 9 (4.8%) without favorable results.Conclusion: CT guided PTSNDH is a safe, accurate, effective and minimally aggressive technique, and is worth being practiced clinically.