腰椎间盘突出症经椎间孔硬膜外封闭的早期效果

Early clinical outcomes of transforaminal epidural block for lumbar disc herniation

[目的]通过与常规保守治疗比较,评价经椎间孔硬膜外封闭治疗腰椎间盘突出症的早期临床效果。[方法] 2016年3月—2019年1月收治单纯腰椎间盘突出症患者50例;其中,28例采用经椎间孔硬膜外封闭,22例采用常规保守治疗。比较两组早期临床结果。[结果]封闭组治疗后26例患者症状迅速改善;随访期间3例患者因相同部位疼痛,4周后再次行封闭治疗;2例无效,1例转行开放手术,1例转行微创手术。保守治疗12例患者症状1周左右改善。至末次随访时,10例治疗无效,5例转行开放手术,5例转行微创手术。两组患者随访至少12周。治疗后2~12周,两组患者VAS和ODI评分较治疗前显著下降(P<0.05),治疗后2~12周时,封闭组的VAS和ODI评分均显著优于保守组(P<0.05)。[结论]经椎间孔硬膜外封闭术中短期效果良好,疼痛症状改善迅速,部分患者病情可以完全缓解,避免手术治疗。

[Objective] To evaluate the early clinical outcomes of transforaminal epidural block for lumbar disc herniation by comparison with conventional conservative treatment. [Methods] A total of 50 patients with simple lumbar disc herniation were admitted into our hospital from March 2016 to January 2019. Of them, 28 patients received transforaminal epidural block, while the remaining 22 patients underwent conventional conservative treatment. The early clinical outcomes were compared between the two groups. [Results] Among 28 patients in the block group, 26 patients got rapid symptom relief after the treatment, despite of the fact that 3 patients had recurrent pain in the same level and received the block again 4 weeks later;the remaining 2 cases failed to the transforaminal epidural block, 1 patient turned to open discectomy, and 1 turned to minimally invasive discectomy. By contrast, of the 22 patients in the conservative group, 12 patients got considerable improvement in 1 week, whereas 10 patients failed to the conservative treatment, 5 underwent open discectomy and5 received minimal invasive discectomy at the end of follow-up. All patients in both groups were followed up for more than 12 weeks. The VAS and ODI scores significantly decreased at 2-12 weeks after treatment compared with those before treatment in both groups(P<0.05).At 2~12 weeks after treatment, the block group proved significantly superior to the conservative group regarding VAS and ODI scores(P<0.05). [Conclusion] The transforaminal epidural block does achieve good short-term outcomes with rapid improvement of pain symptoms.Pain can be relieved completely with no need for further surgical intervention in some patients.