可视化超声引导腰椎选择性神经根阻滞的临床应用研究

The clinical application of visualized ultrasound-guided lumbar selective nerve root block

目的明确可视化超声引导下腰神经根阻滞治疗神经根性的腰腿痛的可行性、有效性及安全性。方法选取神经根性腰腿痛患者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。在各自靶点定位方法下实施选择性腰神经根阻滞治疗,并根据患者疼痛缓解状况疗程式治疗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 B、C组治疗用药量、治疗次数、治疗相关合并症及疼痛缓解程度、TNF-α表达改善均优于A组,有统计学意义(P<0.05);治疗后C组局部血肿概率最小。结论超声可视化技术等同于放射可视化引导的腰神经根阻滞治疗效果,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 To determine the feasibility, efficacy and safety of visualized ultrasound-guided lumbar nerve root block in the treatment of lumbsacral radicular pain. Methods Ninety patients with lumbsaeral radicular pain were divided into conventional treatment group （group A） , radiation-guided group （group B） or ultrasound-guided group （group C） ,30 in each group. Selective lum- bar nerve root block therapies were performed under the respective target localization methods, respectively. The treatment schedule was 2 to 5 times according to the patient＇s pain relief status, and the treatment interval was one week. The levels of plasma TNF-α in the pa- tients before and after treatment were＇ compared, and the patients were followed up with visual analogue scale （VAS） to record the patients＇ pain. Results The dosage, frequency of the treatment, treatment related complications, pain relief status and the expression of TNF-α in the groups B and C were better than those in the group A （ P 〈0. 05 ）. After the treatments, the group C showed the lowest lo- cal hematoma. Conclusion The curative effect of the ultrasound visualization technology is equivalent to that of radiation-guided lum- bar nerve root block treatment with less associated complications. Therefore, it is an environmentally friendly, safe and effective visual- ized adjuvant therapy.