选择性神经根阻滞术在腰椎椎间孔狭窄症治疗中的有效性研究

The effectiveness study of selective nerve blocksurgery in lumbar foraminal stenosis therapy

目的作为阶梯式治疗方法之一,评价选择性神经根阻滞术(selective nerve root block,SNRB)对腰椎椎间孔狭窄症(1umbar foraminal stenosis,LFS)的疗效。方法选取我科收治的LFS患者56例,Wildermuth分级:1级30例,2级26例,根据症状、体征及影像学表现,明确责任间隙,局麻下行SNRB术,术前术后随访患者VAS和JOA评分,Nakai分级标准评价术后疗效。结果随访3-15个月,平均12.8个月,5例后期行椎间孔微创手术,4例行开放融合手术,SNRB手术短期优良率达80%,VAS评分术前腰痛、腿痛评分分别为(6.5±1.9)、(7.2±1.3),术后1d分别为(3.1±1.2)、(2.5±0.8),末次随访分别为(3.5±0.8)、(2.8±1.2)分,JOA评分术前、术后、末次随访分别为(13.8±4.2)、(24.5±3.8)、(23.1±2.6)分。VAS、JOA术后和末次随访较术前差异均有明显统计学意义,术后1d和末次随访评分无统计学差异。结论 SNRB作为阶梯治疗方式在腰椎椎间孔狭窄症中疗效确切,SNRB不仅是一种诊断方式,也是一种行之有效的治疗方式。

Objective Evaluate the clinical effect of selective nerve block surgery in lumbar foraminal stenosis as a step-down therapy. Methods A retrospective study of 56 patients with LSF in our department, whose age is from 32 to 78. According to the classification of Wildermuth by magnetic resonance imaging, Level 1 is of 30 cases, 2 levels of 26 cases. According to the symp- toms, signs and imaging findings, the patients had received the treatment of selective nerve block surgery. Preoperative and postoperative achieved the VAS and JOA scores. We usedtheNakaiclassifi- cation standard to evaluate the effect ofoperation. Results Followed up for 3 to 15 months, 5 cas- es received the percutaneous endoscopic lumbar discectomy,4 underwent open posterior lumbarinter- body fusion. Short-term satisfaction rate for SNRB surgery was 80%, the VAS score preoperative waist pain, leg pain scores were 6.5±1.9,7.2±1.3, postoperative 1 day were3.1±1.2,2.5±0.8, the last follow-up were 3.5±0.8,2.8±1.2. JOA score before operation, postoperative, the last follow-up were 13.8±4.2,24.5±3.8,23.1±2.6. VAS and JOA scores postoperative follow-up have obvious difference compared with preoperative statistical significance.No statistical difference between the last group. Conclusion SNRB as anescalation therapy in lumbar foraminal stenosis is clinically effective, SNRB is not only a diagnostic mode, it is an effective treatment.