X线引导下经椎间孔硬膜外注射治疗腰椎间盘突出症的疗效观察

Fluoroscopically-guided transforaminal epidural steroids injection in the treatment of lumbar herniation

目的探讨X线引导下经椎间孔硬膜外注射(transforaminal epidural steroids injection,TFESI)治疗腰椎间盘突出症的临床疗效。方法回顾性分析2014年5月至2017年5月我院收治并经X线引导下行TFESI治疗的156例腰椎间盘突出症病人的临床资料,将其纳入观察组,将同期采用牵引、推拿、卧床等保守治疗的150例腰椎间盘突出症病人纳入对照组。收集并比较两组治疗前后的疼痛视觉模拟量表(visual analogue scale,VAS)评分及Mac Nab治疗有效率。结果观察组均顺利完成硬膜外注射,无严重并发症发生,8例病人术后出现下肢乏力,于术后3~6 h后恢复;2例病人术后出现头晕、头痛及恶心等症状,于卧床休息后好转。对照组和观察组治疗后的VAS评分分别为(2.21±0.41)分、(1.56±0.32)分,均显著低于同组病人治疗前水平,且观察组得分明显低于对照组,差异均具有统计学意义(P均<0.05)。末次随访时,观察组有102例显效,26例有效,28例无效,总有效率为82.1%;对照组有68例显效,19例有效,63例无效,总有效率为58.0%,差异有统计学意义(P<0.05)。结论 X线引导下TFESI治疗腰椎间盘突出症临床疗效好,是介于保守治疗与手术治疗之间的一种有效方法。

Objective To evaluate the clinical outcome of fluoroscopically-guided lumbar transforaminalepidural steroids injection（TFESI） in treating patients with lumbar disc herniation. Methods A retrospectiveanalysis was performed on 156 cases of lumbar disc herniation undergoing fluoroscopically-guided TFESIbetween May 2014 and May 2017, and 125 cases were enrolled in control group given the conservativetreatment including traction, message and hard bed rest. The visual analogue score（VAS） and Mac Nab criteriawere used to evaluate the effects at last follow-up. Results There were no severe complications. Eight patientsfelt weakness of lower extremities postoperatively and recovered in 3-6 h. The symptoms as dizziness, headacheand nausea occurred in 2 patients postoperatively and relived after bed rest. The VAS scores after treatment inthe control group and observation group were 2.21 ± 0.41 and 1.56 ± 0.32 respectively, both decreasedsignificantly as compared with those before treatment, and those in observation group were significantly lowerthan those in control group（P〈0.05 for all）. According to Mac Nab criteria, in the observation group, 102 caseswere markedly effective, 26 cases were effective, 28 cases were invalid, and the total effective rate was 82.1%,while 68 cases were markedly effective, 19 cases were effective, 63 cases were invalid, with the total effectiverate was 58.0% in the control group（P〈0.05）. Conclusion Fluoroscopically-guided lumbar transforaminalepidural steroids injection is an effective and safe therapy to patients with lumbar herniation.