X线引导下棘突间封闭术诊治腰椎吻合棘的初步临床疗效评价

Preliminary curative effect of interspinous blocking injection guiding by X-ray for the diagnosis and treatment of lumbar Baastrup's disease

目的：评价在X线引导下棘突间封闭术治疗腰椎吻合棘（Baastrup病）所引起腰痛的临床疗效。方法：2011年11月至2013年3月收治的Baastrup病患者17例，男7例，女10例；年龄40～71岁，平均为49．6岁；病史2～5年，平均3．7年。17例患者均采用X线引导下棘突间封闭术进行诊治，在术前、术后2 d、3个月及末次随访时进行疼痛视觉模拟量表（visual analogue scale，VAS）评分和测量腰椎节段活动度范围（range of motion，ROM）评价其总体手术效果，并使用改良Macnab标准进行疗效评价。结果：所有患者获得随访，时间6～10个月，平均7．6个月。术前VAS评分为6．41±0．94，术后各时间段VAS评分均较术前明显改善（P＜0．01），术后各时间段VAS评分之间差异无统计学意义（P＞0．05）。术前病椎节段ROM为（4．88±0．86）°，邻近节段为（6．82±0．73）°，术后各时间段病椎节段ROM较术前有明显改善（P＜0．05），邻近节段ROM较术前无明显改善（P＞0．05）。按照改良Macnab标准，优6例，良7例，可3例，差1例。结论：X线引导下棘突间封闭术是诊治Baastrup病的有效方法，其操作简单，微创、安全，能有效减轻腰背疼痛，近中期疗效明确。

Objective：To evaluate the preliminary curative effect of interspinous injections for the diagnosis and treatment of back pain caused by lumbar kissing spine （Baastrup＇s disease） under fluoroscopically guiding. Methods：From November 2011 to March 2013,17 patients with back pain caused by Baastrup＇s disease were treated with fluoroscopically guided inter-spinous injections,including 7 males and 10 females with an average age of 49.6 years old ranging from 40 to 71 years old;the duration of the disease ranged from 2 to 5 years with a mean of 3.7 years. The visual analogue scale （VAS） and the lumbar seg-ments range of motion （ROM） was analyzed at pre operation,2 days,3 months and final followed up after operation,the effects were evaluated with modified Macnab standard. Results：All patients were follow up from 6 to 10 months with an average of 7.6 months. The pre operative VAS was 6.41±0.94,the postoperative VAS at different time points improved significantly comparing with pre operation,and the differences were statistically significant （P〈0.01）. There was no significant difference in VAS at different time points after operation （P〉0.05）. The ROM of operated segment and adjacent segment was （4.88±0.86）° and （6.82±0.73）° respectively at pre operation. The postoperative operated segment ROM at different time points improved signifi-cantly comparing with pre operation,and the differences were statistically significant （P〈0.05）. Compared with pre operation, there was no significant difference in adjacent segment ROM at different time points after operation （P〉0.05）. According to modified Macnab,the result was excellent in 6 cases,good in 7 cases,fair in 3 cases and poor in 1 case. Conclusion：Fluoro-scopically guided interspinous injections is an effective method for the diagnosis and treatment of Baastrup＇s disease. The method has advantages of simple operation,minimal invasion and safety,satisfactory short term and medium term therapeutic effect;it can also effectively lessen the pain of lumbar and back.