X线引导经颈椎间孔类固醇激素注射在神经根型颈椎病中的应用

Application and evaluation of cervical epidural roid injections for cervical radiculopathy

目的探讨X线引导经颈椎间孔类固醇激素注射在神经根型颈椎病中应用的价值及安全性。方法回顾性分析2015-01—2019-06平顶山市第五人民医院收治并行X线引导下经颈椎间孔类固醇激素注射诊治的神经根型颈椎病患者134例,其中104例确诊患者接受治疗,30例诊断不明确的在明确诊断及确定责任节段后接受治疗。对所有患者的影像资料、临床资料、手术时间、操作是否成功、手术并发症情况进行详细记录,并记录所有患者术前、术后、术后1个月及术后3个月的NDI及VAS评分。结果所有患者的X线引导下经颈椎间孔类固醇激素注射操作均顺利完成,操作时间(14.4±5.1)min。术中行造影剂显影脊神经的均成功。全组患者未出现严重并发症,术后出现头晕和上肢乏力4例,卧床休息数小时后恢复。治疗组、诊断组患者治疗后及各随访点的NDI评分和VAS评分均明显好于治疗前,差异有统计学意义(P<0.05)。8例(5.9%)患者接受CESIs治疗后,症状缓解不明显,后经3个月观察随访仍无明显缓解甚至加重,最终转行手术治疗。结论X线引导经颈椎间孔类固醇激素注射是治疗神经根型颈椎病的一种有效方式,也可用于复杂神经根型颈椎病的确诊及责任节段的定位,且操作简单、安全。

Objective To study the safety and applied value of cervical epidural roid injections(CESIs)for the cervical radiculopathy.Methods A retrospective analysis of 134 cases who received fluoroscopy-guided CESIs for the diagnosis and treatment of cervical radiculopathy in our hospital between January 2015 to June 2019 was conducted.Of these cases,104 who were diagnosed as cervical radiculopathy underwent therapeutic CESIs,and rest 30 were given CESIs to identify exactly the symptomatic level(s).The clinical characteristics,imaging data,success or failure of operation,operating time and complications were recorded.The visual analogue scale(VAS)and the neck disability index(NDI)preoperation and at each follow-up point were collected.Results Under the guidance of X-ray,the operation of cesis was successfully completed in all the patients,and the average operation time was(14.4±5.1)min.During the operation,the spinal nerve was successfully displayed by contrast medium.There were no serious complications in the whole group,4 patients had dizziness and upper limb weakness,and recovered after several hours of bed rest.The NDI and VAS scores of patients in the treatment group and diagnosis group were significantly better than those before treatment(P<0.05).Eight patients(5.9%)received the treatment of cesis,but the symptoms were not relieved obviously.After 3 months of observation and follow-up,there was no obvious remission or even aggravation.Finally,they were transferred to surgery.Conclusion The fluoroscopy-guided SNRBs process is simple and safe in operation,and it could be used as an effective method for treating cervical radicular pain and determine the responsible level(s).