超声引导下腰神经根阻滞治疗神经根型腰腿痛的学习曲线

The learning curve of ultrasound guided lumbar nerve root block in the treatment of nerve root type lumbocrural pain

目的分析超声引导下腰神经根阻滞治疗神经根型腰腿痛的学习曲线,并总结治疗经验。方法收集我院2014年7月至2015年6月通过二维超声引导下实施腰神经根阻滞治疗的最初100例腰椎间盘突出症神经根型腰腿痛患者,按就诊时间先后顺序,每25例为一个治疗的学习曲线阶段,按顺序分别以A、B、C、D组表示各阶段,对比分析4个阶段治疗中操作时间、药物用量、再次治疗、并发症、治疗后疗效等。结果 A组在操作时间和用药量均高于B、C、D组,差异有统计学意义(P<0.05),B、C、D三组比较,差异无统计学意义(P>0.05);与B、C、D比较,A组患者治疗无效患者较多,出现神经刺激征患者较少,差异均有统计学意义(P<0.05);4组患者治疗后7天及1个月,疼痛VAS评分及ODI评分均较治疗前显著改善,差异有统计学意义(P<0.05)。结论超声引导下腰神经根阻滞治疗神经根型腰腿痛的治疗学习曲线在25例左右达到平台期;穿刺超声解剖定位、药物扩散观察、防范神经根损伤及血肿发生等不良事件是初期操作治疗的关键。

Objective To analyze the learning curve of ultrasound guided lumbar nerve root block in the treatment of nerve root type of lumbar and leg pain, and summarize the experience of the treatment. Methods We collected the first visit 100 patients with lumbar disc herniation undergone lumbar nerve root block therapy under the guidance of two-dimensional ulfrasound in our hospital from July 2014 to June 2015. Taking 25 patients as treatment for a learning curve phase according to the order of treatment time and the stages are represented by A, B, C, D. Comparison and analysis of surgical time and dose, treatment, complications and other treatment af- ter treatment in each stage. Results The operation time and dosage in the A group were higher than those in the B, C and D groups （ P 〈 0. 05 ）. However, the differences among group B, C and D were not significant （ P 〉 0. 05 ）. There were more cases of ineffective treatment but fewer patients with nerve irritation in the group A when compared to the B, C and D groups （ P 〈 0.05 ）. The follow-up of 7 days and 1 month after treatment, the VAS and ODI scores in all the 4 groups were obviously improved （ P 〈 0. 05 ）. Conclusion The learning curve of the treatment in 25 cases reaches a plateau. The puncture ultrasonic anatomy, drug diffusion observation, prevention of nerve root injury and hematoma occurrence of adverse events are the key to early operation treatment.