超声下针刀松解腰骶韧带联合神经根阻滞治疗L5S1极外侧型椎间盘突出症

Ultrasound-guided Lumbosacral Ligament Release Combined with Nerve Root Block for Far-lateral L5S1 Disc Herniation

目的:观察超声引导下经腰骶隧道针刀松解腰骶韧带联合L5神经根阻滞治疗L5S1极外侧型椎间盘突出症的临床疗效。方法:选取L5S1极外侧型椎间盘突出症患者32例,采用超声引导下经腰骶隧道针刀松解腰骶韧带联合L5神经根阻滞进行治疗,每7 d治疗1次,2次为1个疗程。于治疗前、疗程结束时、末次随访时进行疼痛视觉模拟评分(VAS)和腰椎Oswestry功能障碍指数(ODI)评估,对治疗前后VAS评分及ODI评分进行统计分析。结果:32例患者获得随访,平均随访时间为35.76 d。其中3例患者因治疗结束后症状反复发作、影响日常生活选择手术治疗。所有患者在治疗中及随访时均未出现局部血肿、神经血管损伤、脑脊液漏等不良反应。治疗前、疗程结束时及末次随访时患者VAS评分及ODI评分,采用单因素重复测量方差分析,差异均有统计学意义(P<0.01)。结论:超声引导下经腰骶隧道针刀松解腰骶韧带联合L5神经根阻滞治疗L5S1极外侧型椎间盘突出症疗效确切,可缓解患者疼痛,改善腰椎功能,为L5S1极外侧型椎间盘突出症的中西医结合非手术微创治疗提供了一种可视化、精准化的疗法。

Objective:To observe the clinical efficacy of ultrasound-guided lumbosacral ligament release combined with L5 nerve root block(NRB)in the treatment of L5S1 far-lateral disc herniations(FLDH).Methods:32 patients with L5S1 FLDH were selected and treated with ultrasound-guided lumbosacral ligament release combined with L5 NRB.The treatment was performed once every 7 d,2 times for one course.The VAS and ODI scores were recorded and compared at preoperative,postoperative and the last follow-up time.Results:32 patients were followed up for 35.76 d on average.Among them,3 patients underwent surgery for the recurring symptoms after treatment.All patients revealed no local hematoma,neurovascular injury,cerebrospinal fluid leakage and other side-effect during treatment and follow-up.The VAS score and ODI score before,after treatment and at the last follow-up were analyzed by single-factor repeated measurement analysis of variance,and the differences were statistically significant(P<0.01).Conclusion:Ultrasound-guided lumbosacral ligament release combined with L5 NRB in the treatment of L5S1 FLDH has a definite effect,which can effectively relieve patients’pain and improve lumbar spine dysfunction.It provides a visual and precise therapy for non-surgical minimally invasive treatment of L5S1 FLDH with integrated Chinese and Western medicine.