硬膜外腔导管松解联合神经根孔外韧带剥离治疗粘连性腰椎管狭窄症

Comparative Effectiveness Evaluation of Adhesiolysis Combine Selective Percutaneous Extraforaminotomy with Foraminal Ligament Resection and Caudal Epidural Injections in Managing Spinal Stenosis

目的探讨硬膜外腔导管松解、精确药物注射,选择性联合应用神经根孔外韧带剥离技术治疗粘连性腰椎管狭窄症所致腰腿痛的临床疗效。方法 2011-01-2012-06,收治粘连性腰椎管狭窄症患者72例,分成两个治疗组,各36例。对照组采用单纯骶管注射治疗;观察组采用经皮、经骶管入路,行硬膜外腔导管松解、精确药物注射,其中21例选择性联合应用神经根孔外韧带剥离技术。采用Oswestry功能障碍指数、疼痛视觉模拟评分评估患者术后疗效。结果术后末次随访时,两组患者的VAS评分和ODI均较术前明显降低(P<0.05),两组间VAS评分、ODI及ODI改善率比较均具有统计学差异(P<0.05)。结论经皮、经骶管行硬膜外腔导管松解、精确药物注射,选择性联合应用神经根孔外韧带剥离技术,可以有效缓解腰椎管狭窄症所致腰腿痛症状。

Objective To evaluate the effectiveness of percutaneous epidural adhesiolysis combine selective percutaneous extraforaminotomy with foraminal ligament resection in patients with chronic low back and lower extremity pain secondary to lumbar spinal stenosis and compare with fluoroscopically directed caudal epidural injections. Methods Patients were randomly assigned to one of 2 groups with 36 patients in each group. Control group patients received caudal epidural injections with catheterization up to $3 with local anesthetic. Experimental group patients received percutaneous epidural adhesiolysis with targeted delivery and injection of medicine, and twenty-one of them received selective percutaneons extraforaminotomy with foraminal ligament resection simul- taneously. Outcome measures included the Oswestry Disability index （ODI） and Visual analogue scale （VAS） with assessment at preoperative time and the last follow up post treatment. Results At the last follow up, there were significant differences of ODI or VAS score between preoperative and postoperative in both groups, and the ODI recovery rate in the experimental group compare to that in the control group showed significant difference. Conclusion Percutaneous epidural adhesiolysis combine selective percutaneous extraforaminotomy with foraminal ligament resection may be effective in patients with chronic low back and lower extremity pain secondary to lumbar spinal stenosis.