中晚期强直性脊椎炎顽固性脊椎疼痛手术止痛治疗

The Analgesic Treatment of the Intractable Spondylalgia of Mid-later Ankylosing Spondylitis with the Surgical Operation

目的 :初步探讨中晚期强直性脊椎炎顽固性脊椎疼痛手术止痛治疗的机制。方法 :采用选择性脊神经后内侧支切断、棘上棘间韧带及椎间关节囊或 /及骶髂关节囊切除的手术方法。结果 :自 1987年 3月以来共收治本病 6 4例 ,术后经 1～ 10年随访 ,按术后脊椎疼痛降低的程度进行评定 ,有效率为 96 .9% ,优良率为 85 .9%。结论 :中晚期强直性脊椎炎顽固性脊椎疼痛主要由几方面原因引起。其中重要的原因就是脊神经后内侧支受到脊椎炎异常的炎症骨化组织嵌压 ,从而使受侵犯的神经支所分布的脊椎段产生顽固性疼痛。本手术方法简单安全 ,对长期保守治疗无效的中晚期病人 ,能有效地解除或减轻顽固性脊椎疼痛 ,同时可避免长期服用抗风湿类药物所带来的副作用 ,具有临床治疗价值。

Objective: To explore the mechanism of the analgesic treatment of the intractable spondylalgia of the mid later ankylosing spondylitis with the surgical operation.Methods: Applied the operations including the selective apocope of posteromedial rami of the spinal nerves,the excisions of supraspinal ligament and interspinous ligament and interspinal joint capsule or sacro iliac joint capsule.Results: This technique had been applied to 64 patients since Mar.1987.Follow up pcriod was 1 10 years According to the extent of the postoperative spondylalgia relief,evaluation of effective rate 96.9% and the excellent and good results were 85.9%.Conclusions: There are several causes for the intractablc spondylalgia of the mid later ankyloing spondylitis One of the important causes was that the posteromedial rami of spinal nerves were impacted by the abnormal osteophytes of spondylitis,lead to the impacted rami of spinal nerves supply vertebras to produce the intractablc spondylalgia. The method is simplc and worthwhile.For the mid later paticnts who conscrvativc treatment was no effect for long term,it can relieve effectively the intractable spondylalgia and avoid the secondary effect that antirheumatic was taken for a long time. It is value able for clinical application.