腓总神经阻滞在腰椎间盘病变鉴别诊断中的应用

The significance of application of common peroneal nerve block in differential diagnosis of lumbar disc lesions

目的探讨腓总神经阻滞在腰椎间盘病变鉴别诊断中的应用价值。方法 (1)选择小腿外侧疼痛伴麻木感患者15例,完善入组病人的影像学检查:腰椎MRI和患侧膝关节X线正侧位及髌骨轴位像,并连同临床体征制定入组标准。(2)腓总神经阻滞穿刺点:患侧腓骨小头与腓骨颈之间;注射药物:0.5%利多卡因1 ml+甲强龙20 mg+甲钴胺500μg+生理盐水至4 ml;疗程:1次/周,共3次。(3)补救性腰椎旁神经阻滞。观察指标:根据单纯腓总神经阻滞后的临床症状缓解程度来判断临床诊断的正确率:(1)治疗前、后疼痛症状缓解程度(VSA疼痛评分);(2)治疗前、后患侧足背屈肌力恢复情况比较;(3)补救性腰椎旁神经阻滞的疗效评估。结果通过15例患者治疗前、后VAS疼痛评分及足背屈肌力临床疗效的比较,确定腓总神经卡压综合征诊断的准确性。结果显示:(1)腓总神经阻滞后VAS疼痛评分值显示,12例获得良好的效果,诊断正确率为80.0%。治疗前较治疗后VAS疼痛评分下降,差异有统计学意义(P<0.05)。足背屈肌力分级分布在Ⅳ级和Ⅴ级的人数比率高于治疗前,差异有显著性(P<0.05)。(2)3例单纯阻滞后临床症状未得到明显缓解,行补救性椎旁神经阻滞后,VAS疼痛评分值有所下降,足背屈肌力分级也有所提高,说明此3例患者的下肢疼痛源于腰椎病变,腓总神经阻滞方法矫正了20.0%的误诊率。结论应用腓总神经阻滞在腰椎间盘病变鉴别诊断中具有显著的临床意义。

Objective To explore the significance of application of common peroneal nerve block in differential diagnosis of lumbar disc lesions. Methods Fifteen patients with pain and numb in external side of lower limbs under the knee were chosen for this study,their image examinations with lumbar nuclear magnetic resonance imaging（ MRI）,anteroposterior and lateral X-ray films of diseased knee joint and axial X-ray of patella were examined. The standard to be included in the group in which common peroneal nerve block was performed firstly,lumbar MRI indicated lumbar disc lesion existed but the lesion was not at the same side of diseased limbs; secondly,lumbar MRI indicated lumbar disc lesion was at the same side of diseased limbs but signs of compressed lumbosacral nerve didn＇t have significant anatomical continuity; thirdly,lumbar MRI indicated lumbar disc lesion was related to the position of diseased limb but it didn＇t have signs of lumbosacral pain and root neuralgia; fourthly,abnormal movement and sense in common peroneal nerve distribution area was found; fifthly,X-ray films of knee joint indicated obvious knee osteoarthrosis with narrowed joint cavity at lateral side and bone neoplasm was found; sixthly,a medical history of fatigue,sprain,or crash in knee of the diseased limb in recent few days had been reported; finally,the common peroneal nerve tension experiment was positive. The puncture site of common peroneal nerve block was at the location between capitis fibulae and neck of fibula at the diseased side. A saline solution with 0. 5% lidocaine 1 ml,methylprednisolone 20 mg,and mecobalamin 500 μg were injected. The therapeutic course was once a week and three times in total.The paravertebral lumbar nerve block was performed as a remedial measure. The items were observed as follows： firstly,the change of pain intensity before and after the treatment; secondly,the change in strength of dorsal flexor muscle of foot before and after the treatment; thirdly,the therapeutic effect of paravertebral lumbar nerve block performed can be as a remedial measure. Results The syptoms of twelve patients had significantly been improved after the treatment with common peroneal nerve block（ P〈0. 05）. The severity of their symptoms in 3 patients had been decreased. The effective rate of common peroneal nerve block in the differential diagnosis for lumbar disc lesions was 80% according to the clinical judgement. Conclusion The application of common peroneal nerve block in the differential diagnosis for lumbar disc lesions is significantly meaningful in the clinical practice.