超声引导下选择性神经根阻滞在复杂腰椎退行性病变诊疗中的应用价值及安全性

Application value and safety of ultrasound-guided selective nerve root block in the diagnosis and treatment of complex degenerative lumbar diseases

目的评价超声引导下选择性神经根阻滞在复杂腰椎退行性病变患者诊疗中应用的价值及安全性。方法选取2018年6月至2020年9月北京积水潭医院脊柱外科病区收治的复杂腰椎退行性病变患者364例。采用超声引导下选择性神经根阻滞明确责任节段后行椎管神经根减压术。观察手术指标,术前、术后第3天及1个月采用疼痛视觉模拟量表(VAS)评分评价疼痛程度,采用腰痛功能障碍指数(ODI)评价功能程度。采用Macnab腰腿痛手术治疗评定标准进行疗效评定,观察手术并发症发生情况。结果患者手术时间(74±40)min,术中出血量(77±31)ml。患者术前VAS评分为(7.8±0.8)分、ODI为(44.4±4.6);术后第3天VAS评分为(3.0±0.5)分、ODI为(18.2±2.6),术后1个月VAS评分为(2.4±0.6)分、ODI为(14.1±3.9);术后第3天及1个月患者VAS评分、ODI均低于术前,差异均有统计学意义(均P<0.05)。364例患者疗效达优256例(70.3%),均未发生感染、脊髓或重要神经血管损伤等严重并发症。结论超声引导下选择性神经根阻滞可准确地指导手术治疗复杂腰椎退行性病变,安全性高。

Objective To evaluate the application value and safety of ultrasound-guided selective nerve root block(SNRB)in the diagnosis and treatment of complex degenerative lumbar diseases.Methods From June2018 to September 2020,364 patients with complex degenerative lumbar diseases admitted to Department of Spinal Surgery,Beijing Jishuitan Hospital were enrolled.They were treated with spinal canal nerve root decompression after identifing responsible segment by ultrasound-guided SNRB.The operation indexes were observed,pain degree before operation,3 d and 1 month after operation were assessed by pain visual analogue scale(VAS),and the functional degree was evaluated by Oswestry disability index(ODI).The curative effect was evaluated according to Macnab criteria for surgical treatment of lumbocrural pain.The surgical complications were observed.Results The average operation time was(74±40)min and the mean intraoperative blood loss was(77±31)ml.The preoperative VAS score of patients was(7.8±0.8)and ODI was(44.4±4.6);3 d after operation,the VAS score was(3.0±0.5)and ODI was(18.2±2.6);1 month after operation,VAS score was(2.4±0.6)and ODI was(14.1±3.9);the VAS scores and ODI at 3 d and 1 month after operation were significantly lower than those before operation(all P<0.05).There were 256 cases(70.3%)with excellent results in364 patients.No serious complications such as infection,spinal cord or important neurovascular injury occurred.Conclusion Ultrasound-guided SNRB can accurately guide the surgical treatment of complex degenerative lumbar spine lesions with high safety.