选择性神经根阻滞在腰椎有限手术中的应用

Application of selective nerve root blocks in limited operation of the lumbar spine

目的：总结选择性神经根阻滞在腰椎有限手术中的临床应用结果。方法：2008年1月至2012年10月，对68例多平面腰椎管狭窄症患者采用选择性神经根阻滞，其中男47例，女21例；年龄45～80岁，平均56岁。神经根阻滞后64例为阳性患者进行了腰椎有限手术，另4例封闭后症状减轻不明显为阴性，难以确定手术平面或引起症状的神经根，放弃了手术治疗。术后采用Macnab腰腿痛手术治疗评定标准进行疗效评定。结果：神经根阻滞操作过程顺利，未发生与神经根阻滞相关的并发症，术后无神经损伤并发症。术后随访16～45个月，平均32个月。术后根据Macnab腰腿痛手术治疗评定标准进行疗效评定，优44例，良18例，差2例。结论：对腰椎管狭窄症的手术治疗重点应放在压迫引起症状的部位，而对无症状的部位不做预防性减压操作。应用神经根阻滞能准确判断责任椎与疼痛源，提高腰椎有限手术的疗效。

To summarize the clinical application result of the selective nerve root blocks in limited operation of the lumbar spine. Methods From January 2008 to October 2012,68 patients with lumbar spinal canal stenosis with multi-ple levels were underwent the selective nerve root blocks in limited operation of the lumbar spine, including 47 males and 21 females with an average age of 56 years old ranging from 45 to 80. After never roots blocks,64 cases were positive for limited operation of the lumbar spine ; the other 4 cases were negative and abort the operation. Results ： The nerve roots block operation smoothly and no complications related to the nerve roots block occurred. There was no neurologic injury complication in this study. Follow-up period ranged from 16 to 45 months postoperatively （means,32 months）. The recovery effect was calculated with Macnab scores, the result was excellent in 44 cases, good in 18 cases, poor in 1. Conclusion：Operative treatment for lum-bar spinal canal stenosis with multiple levels is focused on the areas causing symptomatc neural compression rather than pro- phylactic decompression at areas of nonsymptomatic disease. Application of selective nerve root blocks can accurately judge the responsible vertebral body and pain source and improve the curative effect of limited operation of the lumbar spine