新型定位板在经椎间孔腰骶神经根封闭术术前定位中的应用

Preoperative localization for transforaminal lumbosacral nerve root blocks with a new type of orientating plate

目的 :探讨新型定位板应用在腰椎后外侧经椎间孔腰骶神经根封闭术的术前定位中的有效性、可靠性。方法:2015年3月~2016年3月收治腰椎退行性疾病患者102例,其中单节段腰椎间盘突出症51例,单节段腰椎管狭窄症42例,经皮内窥镜下腰椎间盘切除术后症状复发9例,采用随机数字表随机分入两组后行腰椎后外侧经椎间孔腰骶神经根封闭术。A组54例,手术节段为L3/4 8例、L4/5 28例、L5/S1 18例,采用新型定位板术前定位;B组48例,手术节段为L3/4 8例、L4/5 26例、L5/S1 14例,采用金属定位针术前定位。两组患者年龄、性别、手术节段、保守治疗时间均无统计学差异(P>0.05)。记录两组术前的透视次数和准备时间、穿刺时间、穿刺期透视次数、手术并发症、穿刺术后1h穿刺区疼痛VAS评分,并进行统计学分析。结果:A组术前的准备时间为5.2±1.0min、透视次数为1.1±0.3次,穿刺时间9.6±2.2min,穿刺期透视次数3.1±1.0次;B组术前的准备时间为10.7±2.3min、透视次数为3.8±1.2次,穿刺时间16.3±3.3min,穿刺期透视次数4.6±0.6次,两组比较均有统计学差异(P<0.05),A组均优于B组。两组均未出现椎管内血肿、腹腔脏器损伤、下肢感觉和运动功能异常,B组出现硬膜刺裂1例(1/48)、穿刺区域皮下血肿4例(4/48),两组并发症发生率无统计学差异(P>0.05);术后1h穿刺区域疼痛VAS评分,A组为3.4±0.5分,B组为5.0±0.9分,有统计学差异(P<0.05)。结论:对于经椎间孔腰骶神经根封闭术,使用新型定位板术前定位,并进行穿刺路径设计,可减少术前透视次数、术前准备时间,有助于缩短穿刺时间及穿刺期透视次数,定位板具有使用方便、可靠、有效等优点。

Objectives： To discuss the effectiveness and reliability of using a new type of orientating plate for lumbar posterolateral transforaminal lumbosacral nerve root blocks. Methods： 102 patients with lumbar degenerative diseases were enrolled in the study between March 2015 and March 2016, including single-segment lumbar disc herniation in 51 cases, single-segment lumbar spinal stenosis in 42 cases, recurrence after percutaneous endoscopic lumbar discectomy in 9 cases. All patients received lumbar posterolateral transforaminal lumbosacral nerve root blocks after being divided into two groups with the random number table. Group A： 54 patients were performed with new type of orientating plate before operation, including 8 cases in L3/4 level, 28 cases in L4/5 level, 18 cases in L5/S1 level. Group B： 48 patients were performed with metal locating needle, including 8 cases in L3/4 level, 26 cases in L4/5 level, 14 cases in L5/S1 level. There were no significant differences in age, sex, operative level, conservative treatment time between the two groups（P〉0.05）. The preoperative fluoroscopy times, the preparation time, the puncture time, the fluoroscopy times during puncturing, the complication of operation, the VAS pain score of the punctured area 1h after operation were measured and analyzed. Results： In group A, the preparation time was 5.2±1.0min, the preoperative fluoroscopy times were 1.1±0.3, the puncture time was 9.6±2.2min and the fluoroscopy times during puncturing were 3.1±1.0, while in group B, the preparation time was 10.7±2.3min, the preoperative fluoroscopy times were 3.8±1.2, the puncture time was 16.3±3.3min, the fluoroscopy times during puncturing were 4.6±0.6, there were significant differences between group A and group B（P〈0.05）. There were no intraspinal hematoma, abdominal organ injury, impairment of sensory and motor functions in lower limbs between two groups. The dural puncture occurred in 1 case of group B（1/48）. The subcutaneous hematoma of punctured area occurred in 4 cases of group B（4/48）. There was no significant difference in the rate of complications between two groups（P〉0.05）. The VAS pain score of the punctured area 1h after operation was 3.4±0.5 in group A and 5.0±0.9 in group B, there was significant difference between group A and group B（P〈0.05）. Conclusions： For transforaminal lumbosacral nerve root blocks, preoperative location and the design of puncture track by using new type of orientating plate can reduce the preoperative fluoroscopy times, the preoperative preparation time, and help to shorten the puncture time and the fluoroscopy times during puncturing, therefore, new type of orientating plate is easy to use, reliable and effective.