腰椎间盘突出症术中神经根鞘内及其周围用药疗效研究

Therapeutic Effect of Intraoperative Intrathecal and Perithecal Injection of Nerve Blocks on Reducing the Radicular Pain Following Surgery for Lumbar Disc Herniation

背景传统的骶管注射或术中使用神经阻滞药物是治疗腰椎间盘突出症(LDH)或术后早期炎性水肿引起的神经根性疼痛的有效方法。然而,用于神经根鞘内及其周围的神经阻滞药物作用时间短,疗效有限,仍有进一步研究的必要性。目的观察LDH术中神经根鞘内及其周围用药的临床疗效。方法根据纳入与排除标准,选取2015年3月—2018年3月于广西中医药大学第一附属医院行椎板开窗髓核摘除、神经根管扩大术治疗的LDH患者90例。采用随机数字表法将患者分为A组(n=30,给予神经根鞘内及其周围用药)、B组(n=30,给予神经根鞘内用药)、C组(n=30,不做特殊处理)。收集患者一般资料、术后卧床时间、术后住院时间、术后神经根性疼痛情况;记录术前及术后第1、3、6、10天视觉模拟评分法(VAS)评分,第3、6、10天日本骨科学会治疗评估评分法(JOA)评分;观察不良反应发生情况。结果 B组、C组术后卧床时间、术后住院时间长于A组,术后神经根性疼痛发生率高于A组(P<0.05);C组术后卧床时间、术后住院时间长于B组,术后神经根性疼痛发生率高于B组(P<0.05)。干预方式与时间在VAS评分上存在交互作用(P<0.05);干预方式、时间在VAS评分上主效应显著(P<0.05)。B组、C组术后第1、3、6、10天VAS评分高于A组(P<0.05);C组术后第1、3、6、10天VAS评分高于B组(P<0.05)。A组、B组、C组术后第1、3、6、10天VAS评分均低于本组术前(P<0.05)。干预方式与时间在JOA评分上存在交互作用(P<0.05);干预方式、时间在患者JOA评分上主效应显著(P<0.05)。B组、C组术后第6、10天JOA评分低于A组(P<0.05);C组术后第6、10天JOA评分低于B组(P<0.05)。A组、B组、C组术后第3、6、10天JOA评分均高于本组术前(P<0.05)。3组患者均无明显不良反应。结论 LDH术中神经根鞘内及其周围用药可能通过提高药物的作用时间来延长镇痛时间,促进LDH术后早期恢复,减轻术后神经根性疼痛,减少卧床时间及住院时间,提高术后疗效。

Background Traditional sacral canal or intraoperative injection of nerve blocks is an effective treatment for radicular pain caused by lumbar disc herniation(LDH)or inflammation-induced edema soon after the surgery for LDH. However,this treatment has a short duration of action and limited efficacy,and there is still a need for further research. Objective To explore the clinical efficacy of intraoperative intrathecal and perithecal injection of nerve blocks for reducing the pain following surgery for LDH.Methods According to the inclusion and exclusion criteria,90 LDH patients who underwent open discectomy for the removal of herniated nucleus pulposus and nerve root canal decompression with foraminal enlargement in the First Affiliated Hospital of Guangxi University of Chinese Medicine from March 2015 to March 2018 were selected.By a random number table,they were divided into group A(n=30,receiving intraoperative intrathecal and perithecal injection of nerve blocks),group B(n=30,receiving intraoperative intrathecal injection of nerve blocks),group C(n=30,receiving no intraoperative injection of nerve blocks).General data,postoperative bedridden time,postoperative hospital stay, postoperative radicular pain,Visual Analogue Scale(VAS)scores assessed before surgery and on the 1st,3rd,6th,and 10th days after surgery,Japanese Orthopedic Association(JOA)scores assessed before surgery and on the 3rd,6th,and 10th days after surgery,were collected.The incidence of adverse reactions was also obtained.Results Group A showed much shorter postoperative bedridden time and postoperative hospital stay,and much lower incidence of postoperative radicular pain than groups B and C(P<0.05),as did group B when compared with group C(P<0.05).Both the treatment method and duration had a significant interaction on the VAS score(P<0.05).And they produced significant main effects on the VAS score(P<0.05). The VAS scores on the 1st,3rd,6th,and 10th days after surgery were all significantly lower than the baseline level in all groups (P<0.05).Group A demonstrated much lower VAS scores on the 1st,3rd,6th,and 10th days after surgery compared with groups B and C(P<0.05),as did group B when compared with group C(P<0.05).There was an interaction between the treatment method and duration on the JOA score(P<0.05).The main effects of the treatment method and duration on the JOA score were significant(P<0.05).The JOA scores on the 3rd,6th,and 10th days after surgery in all groups increased significantly compared with the baseline level(P<0.05).Group A demonstrated much higher JOA scores on the 6th and 10th days after surgery compared with groups B and C(P<0.05),as did group B when compared with group C(P<0.05).There were no significant adverse reactions in all groups.Conclusion Intraoperative intrathecal and perithecal injection of nerve blocks for LDH can achieve a longer duration of pain relief via extending the duration of action of the drugs,which in turn significantly promotes early postoperative recovery,relieves the postoperative radicular pain,and shortens the postoperative bedridden time and postoperative hospital stay,thus increasing the overall efficacy.