脊神经后支神经痛诊治及其解剖学基础

Diagnosis and treatment of neuralgia of posterior branch of spinal nerves and its anatomical basis

目的介绍脊神经后支神经痛诊断与治疗及其解剖学基础。方法回顾性分析我院软组织门诊诊断为脊神经颈、胸、腰段后支神经痛62例,诊断仅靠检查皮肤痛觉决定,治疗皆采用强的松龙加局部麻药依据其解剖学基础,药物注射至神经穿出斜方肌或背阔肌的肌性部或其腱膜处,注射部位在颈、胸、腰段各有不同。在注射后5~10 min内止痛,可以立即判断诊断无误。结果 62例皆在注射后5~10 min疼痛消除,治疗后痊愈49例,经第2次注射后痊愈11例,经第3次注射后痊愈2例,注射时间间隔1周。结论对于确诊为脊神经后支神经痛的病例,按颈、胸、腰段不同部位注射强的松龙加局部麻药的方法,紧密结合其解剖学基础,可以获得良好的疗效,不失为首选的治疗方法。

Objective To introduce the anatomical basis for diagnosing and treating neuralgia of the posterior branch of spinal nerves.Methods Totally 62 cases of diagnosed neuralgia of the posterior branch of spinal nerves in cervical,thoracic and lumbar regions were collected among soft tissue diseases in our outpatient department.The diagnosis was made according to the examination of skin perception.All cases were treated by local injection of prednisolone plus local anesthetics to the aponeurosis of trapezus or latissmus dorsi muscle where the nerves is passing through.Injection positions at cervical,thoracic or lumbar region were varied according to the diseased region.The pain was stopped in all cases several minutes after injection demonstrating that no mistake was made in the diagnosis.Results The pain was disappeared in all cases several hours after injection.In all,49 cases recovered after the first injection,11 cases recovered after second injection and 2 cases recovered after the third injection at an interval of one week.Conclusion Satisfactory treatment effect could be obtained by local injection of prednisolone plus local anesthetics to certain places according to the diseased region concerning the cases of diagnosed neuralgia of the posterior branch of spinal nerves.It could be regarded as the best therapy.