选择性神经根封闭治疗极外侧型腰椎间盘突出症的疗效研究

Therapeutic effect of selective nerve root block in far lateral lumbar disc herniation

目的观察选择性神经根封闭治疗极外侧型腰椎间盘突出症(far lateral lumbar disc herniation, FLLDH)的效果。方法回顾性分析本院脊柱外科2013年3月至2018年12月收治的43例FLLDH病人的临床资料,均采用选择性神经根封闭治疗并获得完整随访。43例病人按照椎间盘突出或脱出的部位分为椎间孔内组(19例)和椎间孔外组(24例),收集并比较两组病人治疗后2 h、治疗后3 d及末次随访的腰腿疼痛视觉模拟量表(visual analogue scale, VAS)评分、Oswestry功能障碍指数(Oswestry disability index, ODI)、末次随访时的MacNab疗效评定标准以及治疗后的手术率。结果 43例病人的随访时间为(16.22±9.12)个月(6~24个月)。椎间孔内组病人治疗后2 h、治疗后3 d的VAS评分及ODI均较治疗前显著改善,椎间孔外组治疗后2 h、治疗后3 d及末次随访的VAS评分及ODI均较治疗前明显下降,与术前比较,差异均有统计学意义(P均<0.05)。椎间孔外组治疗后3 d及末次随访时的VAS评分及ODI均显著低于椎间孔内组,两组间比较,差异均有统计学意义(P均<0.05)。参照MacNab疗效评定标准,椎间孔内组和椎间孔外组的优良率分别为36.8%(7/19)、75.0%(18/24),两组的优良率比较,差异有统计学意义(χ~2=6.344,P=0.012)。椎间孔内组与椎间孔外组的手术例数分别为13例和8例,手术率分别为68.4%和33.3%,两组间比较,差异有统计学意义(χ~2=5.225,P=0.022)。结论选择性神经根封闭术可作为治疗FLLDH的供选方案,椎间孔外型的疗效优于椎间孔内型,病人出现神经损害症状时仍需积极手术治疗。

Objective To observe the therapeutic effect of selective nerve root block in far lateral lumbar disc herniation(FLLDH). Methods Forty-three patients with FLLDH who were treated with selective nerve root block therapy in our department from March 2013 to December 2018 were retrospectively analyzed.Based on the lumbar MRI, these patients were divided into two groups: intraforaminal group and extraforaminal group. The pain visual analogue scale(VAS) and Oswestry disability index(ODI) were assessed at 2 h, 3 d after treatment and last follow-up were collected and compared. The MacNab evaluation was assessed at last followup to evaluate the efficacy of surgery. The operation rate of discectomy in the two groups was also counted.Results The patients were followed up for(16.22±9.12) months(6-24 months). The VAS score and ODI at 2 h and 3 d after treatment in the intraforaminal group were significantly improved, the VAS score and ODI at 2 h, 3 d after treatment and the last follow-up in the extraforaminal group were significantly improved, the differences were statistically significant(all P<0.05). The VAS score and ODI at 3 d after treatment and the last follow-up in the extraforaminal group were significantly lower than those in the intraforaminal group, with the differences being statistically significant between the two groups(all P<0.05). According to the MacNab efficacy evaluation criteria, the excellent and good rates in the intraforaminal group and the extraforaminal group were36.8%(7/19) and 75.0%(18/24), respectively. The difference in the excellent and good rates between the two groups were statistically significant(χ~2=6.344, P=0.012). The number of operations in the intraforaminal group and the extraforaminal group was 13 and 8 respectively, and the operation rates were 68.4% and 33.3%,respectively. The difference between the two groups was statistically significant(χ~2=5.225, P=0.022).Conclusion Selective nerve root block is an alternative treatment for FLLDH. The treatment effect of FLLDH for the extra-foramen type is better than that of the intra-foramen type. Active surgical treatment is still required when patients have symptoms of nerve damage.