DSA引导下椎间孔注射联合针刀治疗极外侧型腰椎间突出症的回顾性研究

A Retrospective Study of DSA-guided Intervertebral Foramen Hormone Injection Combined with Needle Knife in the Treatment of Far Lateral Lumbar Disc Herniation

目的:探讨数字减影血管造影(DSA)引导下椎间孔糖皮质激素注射联合针刀治疗极外侧型腰椎间盘突出症的临床疗效.方法:选取2016年1月-2019年12月在我科住院治疗的极外侧型腰椎间盘突出症患者予DSA引导下椎间孔糖皮质激素注射联合针刀治疗,在患者治疗前和治疗后分别采用日本骨科协会评估治疗(JOA)腰椎评分、疼痛视觉模拟评分量表(VAS)对腰腿痛程度和运动功能状态进行比较,并对治疗可能的不良反应及复发率进行观察.结果:DSA引导下椎间孔糖皮质激素注射联合针刀治疗病例27例,穿刺成功率为100%.与治疗前相比,治疗后3天患者VAS评分明显下降(P<0.0083),治疗后1个月及治疗后3个月VAS评分低于治疗前(P<0.0083);治疗后3天、1个月及3个月患者JOA评分与治疗前有显著升高(P<0.0083);无1例患者发生严重不良反应,有3例患者出现症状反复,其中1例需行椎间盘摘除手术治疗.结论:对于极外侧型腰椎间盘突出症的注射治疗,DSA引导下椎间孔糖皮质激素注射联合针刀治疗能明显缓解腰腿痛并改善运动功能,精准穿刺椎间孔、避免损伤刺伤硬脊膜,无重大及不可逆的不良反应.

Objective:To explore the clinical efficacy of DSA-guided intervertebral foramen glucocorticoid injection combined with needle knife in the treatment of far lateral lumbar disc herniation.Methods:Patients with far lateral lumbar disc herniation treated in our department from January 2016 to December 2019 were treated with DSA-guided intervertebral foramen glucocorticoid injection combined with needle knife.Before and after treatment,the patients were evaluated by japanese orthopaedic association scores(JOA)and visual analogue scale(VAS)to compare the degree of low back pain and motor function.The possible adverse reactions and recurrence rate were observed.Results:27 cases were treated by DSA—guided intervertebral foramen glucocorticoid injection combined with needle knife,and the success rate of puncture was 100%.Compared with those before treatment,VAS scores decreased significantly 3 days after treatment(P<0.0083),VAS scores at 1 month and 3 months after treatment were lower than those before treatment(P<0.0083),and JO A scores at 3 days,1 month and 3 months after treatment were significantly higher than those before treatment(P<0.0083).None of the patients had serious adverse reactions,and 3 patients had recurrent symptoms,of which 1 case needed discectomy.Conclusion:For the injection treatment of far lateral lumbar disc herniation,DSA-guided intervertebral foramen glucocorticoid injection combined with needle knife therapy can significantly relieve low back pain and improve motor function,accurately puncture the intervertebral foramen and avoid injury to the dura mater,and there are no major and irreversible adverse reactions.