责任节段神经鞘内注射曲安奈德对腰椎管狭窄症术后疼痛疗效的临床研究

Clinical research of triamcinolone acetonide neural intrathecal injection in responsibility segment on postoperative pain in lumbar spinal stenosis

目的评价曲安奈德术中责任节段神经鞘内注射对腰椎管狭窄症(LSS)患者术后疼痛疗效。方法收集2014年1月至2015年1月在该科行传统椎板开窗减压术的LSS患者86例,根据随机数字表法,将所有患者分为2组。试验组(A组,n=43):术中责任节段神经鞘内注射和神经根周围喷洒曲安奈德注射液;B组(空白组,n=43):术中不做特殊处理。记录各组患者的年龄、性别、病程、下床活动时间、视觉模拟评分法(VAS)评分、日本骨科协会评估治疗分数(JOA)评分、Oswestry功能障碍指数问卷表(ODI)评分,并进行统计学分析。结果所有患者均成功完成手术和分组,无神经损伤、大出血及死亡病例。两组在年龄、性别、病程对比方面均差异无统计学意义(P>0.05)。两组下床活动时间比较差异有统计学意义(P<0.05)。两组间术前、终末随访VAS评分比较差异无统计学意义(P>0.05)。两组VAS评分在术后1、3、7d比较均差异有统计学意义(P<0.05)。两组JOA评分和ODI评分术后3、7d比较差异有统计学意义(P<0.05)。结论传统椎板开窗减压术在治疗LSS时,术中应用曲安奈德进行责任节段神经根干预,可以有效预防患者术后反跳痛症状的发生。

Objective To evaluate the effect of triamcinolone acetonide intraoperative responsibility segmental intrathecal injection for treating postoperative pain in lumbar spinal stenosis（LSS）.Methods Eighty-six LSS patients undergoing traditional lamina windowing decompression in our department from January 2014 to January 2015 were collected and divided into the two groups according to the random number table method.The experimental group（A,n=43）：intraoperative responsibility segmental intrathecal injection and spray around the nerve root of triamcinolone acetonide injection;the group B（blank,n=43）：no special treatment was performed during operation.The age,gender,disease duration,off-bed activity time,VAS scores,JOA score and ODI score were recorded in each group and statistically analyzed.Results All patients were successfully completed surgery and grouping without nerve damage,massive bleeding and death case.There was no statistically significant differences in the aspects of age,sex and disease course between the two groups（P〈0.05）;the off-bed activity time had statistical difference between the two groups（P〈0.05）.Preoperative and terminal follow up VAS score had no statistical differences between the two groups（P〉0.05）.The VAS score on postoperative 1,3,7dhad statistical differences between the two groups（P〉0.05）.The JOA score and ODI score on postoperative 3,7dhad statistical differences between the two groups（P〈0.05）.Conclusion In the traditional lamina windowing decompression for treating LSS,intraoperative application of triamcinolone acetonide responsibility segmental nerve roots intervention can effectively prevent the happening of the rebound tenderness in postoperative patients.