选择性神经根阻滞术在老年人多节段腰椎椎管狭窄症诊断中的应用

Selective nerve root block for diagnosis of multi-segmental lumbar spinal stenosis

目的 探讨选择性神经根阻滞术对多节段腰椎椎管狭窄症的诊断意义及临床价值.方法 回顾分析2008年5月～2011年2月收治的多节段腰椎椎管狭窄症患者42例,所有患者均采用选择性神经根阻滞术明确责任节段.根据责任节段行相应的选择性椎板开窗减压、椎间盘摘除、椎弓根螺钉内固定、后路腰椎椎体间植骨融合术.随访并比较患者术前及术后3个月、6个月、末次随访时日本骨科学会（Japanese Orthopaedic Association,JOA）及疼痛视觉模拟量表（visual analogue scale,VAS）评分,并依据Nakai分级标准对手术效果进行评价.结果 术后随访12～36个月,平均19个月,选择性神经根阻滞术明确单节段责任节段32例,双节段9例,有1例在神经根阻滞后症状缓解＜30％,未再行手术治疗.41例手术均顺利完成,均未发生神经损伤等并发症.患者术后3个月、术后6个月及末次随访时VAS评分、JOA评分较术前明显改善,差异有统计学意义（P＜0.01）.按照Nakai分级标准评定：本组41患者中,优22例、良14例、可5例,总优良率为87.8％.结论 在多节段腰椎椎管狭窄症的定位诊断中,选择性神经根阻滞术是明确责任节段准确而有效的方法,具有良好的临床应用价值.

Objective To explore the diagnostic significance and clinical value of selective nerve root block for multisegmental lumbar spinal stenosis.Methods From May 2008 to February 2011,42 cases of multi-segmental lumbar spinal stenosis were retrospectively reviewed.Selective nerve root block was used in all cases to identify the responsible segment.Based on the results,41 cases were treated by selective fenestration laminectomy decompression,discectomy,pedicle screws instrumentation and posterior lumbar interbody fusion.The patients were followed up,and Japanese Orthopaedic Association （jOA） and visual analogue scale（VAS） scores were compared between preoperation and at postoperative 3 months,6 months and final follow-up.The surgery effects were measured by Nakai criteria as well.Results All patients were followed up 12-36months with an average of 19 months.The responsible segment was identified single level in 32 cases and 2 levels in 9 cases by selective nerve root block.In which 1 cases did not receive further surgical treatment due to a low relief rate of 30%.The surgeries were completed successfully in all patients.There was no such complication as nerve injury and so on.The postoperative JOA and VAS scores at different time points improved significantly compared with that of preoperation,and the differences were statistically significant （P 〈 0.01）.According to the evaluation of Nakai criteria,there were excellent in 22 cases,good in 14 cases,fair in 5 cases.The overall excellent and good rate was 87.8%.Conclusion Selective nerve root block is an effective and accurate method to identify the responsible segment of multi-segmental lumbar spinal stenosis.It has a good clinical application value.