二维成像超声扫描下腰椎选择性神经根阻滞的临床应用研究

目的明确二维成像超声引导下腰神经根阻滞治疗神经根性的腰腿痛的有效性、可行性及安全性。方法随机单盲法选取神经根性腰腿痛患者患者90例分为传统治疗组（A组）、放射引导组（B组）和超声引导组（C组），各30例。每组患者在各自靶点定位方法下进行周期性选择性腰神经根阻滞治疗，并根据患者主观放射感受推注阻滞药物（0．3％利多卡因＋曲安奈德10mg＋0．9%生理盐水混合液累计20m1）最多推注15ml，并根据患者疼痛缓解状况实施治疗2～5次，每次治疗间隔一周。观测记录各组患者治疗用药量、治疗次数、治疗周期、治疗相关合并症，比较治疗前、治疗后3天、2周患者血浆TNF-α水平变化，同时采用视觉模拟评分法（VAS评分）随访记录患者疼痛改善情况。结果1、三组阻滞治疗用药量、治疗次数、治疗周期、治疗相关合并症比较，B、C组均优于A组，有统计学意义（P〈0．05）；2、三组治疗前后疼痛缓解情况（VAS评分）B、C组比较无差异，A组与BC组比较均有统计学意义（P〈0．05）。3、B、C组治疗前后TNF-α表达比较无差异，A组与BC组比较均有统计学意义（P〈0．05）。结论超声可视化等同于放射可视化引导腰神经根阻滞的治疗效果且相关合并症更少，是一种环保、安全、有效的可视化辅助治疗技术。

Objective clear two-dimensional ultrasound imaging guided lumbar nerve root block in the treatment of nerve root pain in waist and lower extremities effectiveness, feasibility and safety. Methods randomized single blind method selected nerve root of backleg pain patients 90 cases divided into conventional treatment group （group A）, radiation guided group （group B） and ultrasound guided group （C group）, with 30 cases in each. Each group of patients in the respective target localization method for periodic selective lumbar nerve root block in the treatment of, and according to the subjective patient radiation feel push note blocking drugs （0.30%lidocaine＋triamcinolone acetonide 10mg＋0.9% saline mixed with liquid tired 20ml） most infusion 15mi And according to the patients pain relief treatment 2-5 times, each treatment interval of a week. Recorded patients treatment dosage, times of treatment, the treatment cycle, treatment related complications, compared with those before the treatment, 3 days after treatment, 2 weeks in patients with plasma TNF-levels. At the same time, the visual analogue scale method （VAS score） were recorded in patients with pain improvement. Results 1. Three groups of block treatment dosage, times of treatment, the treatment cycle, treatment related complications, B, C group was better than that of group A, statistical significance （P〈0.05） ; 2, three groups before and after treatment, the pain relief （VAS rating Points） B and C group had no significant difference between that group A and BC group comparison were statistically significant （P〈0.05）. , B, C group before and after treatment TNF alpha expression had no significant difference between that of B group and C group comparison were statistically significant （P〈0. 05）. Conclusion Ultrasound to visualize equal to radiation visualization to guide the treatment effect of lumbar nerve root block and associated with fewer complications. It is a kind of environmental protection, security, effective visualization assisted therapy technique.