椎旁神经根毁损治疗恶性肿瘤骨转移截瘫患者顽固性癌痛的临床研究

A Clinical Study of the C-Arm X Ray-Guided Paravertebral Nerve Roots Ne-urolytic Block On The Paraplegic Patients With Refractory Pain Due To Bone Metastasis

目的：观察在C形臂引导下行椎旁神经根毁损治疗恶性肿瘤骨转移截瘫患者顽固性癌痛的临床效果。方法：患者俯卧位,选择骨转移截瘫患者疼痛所累及脊神经椎间隙,在C形臂的引导下,行椎旁神经根穿刺,先注入碘海醇3 ml,观察造影剂分布确定针尖邻近神经根,再给予0.5%罗哌卡因3~5 ml,观察15 min,如果疼痛缓解超过50%,给予95%乙醇2~4 ml。记录治疗前、治疗后1天、7天、1个月、2个月患者的VAS评分、吗啡消耗量及可能出现的不良反应。结果：共有15例患者进行了椎旁神经根乙醇毁损治疗,治疗后各时点患者VAS评分及吗啡日消耗量均较治疗前明显降低,所有患者均未观察到严重不良反应。结论：椎旁神经根毁损可以有效缓解恶性肿瘤骨转移截瘫患者的顽固性癌痛,可以作为药物治疗无效者的较佳选择。

Objective： To observe the efficacy of paravertebral nerve roots neurolytic block guided by C-Arm X-ray on the refractory pain due to bone metastasis among paraplegic cancer patients.Methods： All patients were placed in the prone position.Under the guide of C-Arm X ray,the spinal intervertebral space related to the refractory cancer pain was located.3 ml iohexol was injected first to verify the accurate pl-acement of needle,then injected 3 ~ 5 ml 0.5% ropivacaine,if patients reporting more than 50% pain redu-ction after 15 minutes,2 ~ 4 ml 95% alcohol was injected to block the related paravertebral never boots.VAS,daily consumption of morphine and complications were recorded before,1 day,7 days,1 month and 2 months after treatment respectively.Results： 15 patients were enrolled in this study.The VAS and daily consumption of morphine both significantly decreased at each time point after treatment.No complications related to the block were detected.Conclusion： Spinal nerve roots neurolytic block could be a safe and effective choice for the refractory pain of paraplegic patients with bone metastasis,especially for those who suffered uncontrolled pain with drug treatment.