改良超声引导下脊神经后内侧支阻滞治疗腰背痛的临床研究

Clinical study on ultrasound-guided posterior medial branch block of lumbar nerve in the treatment of low back pain

目的:观察改良超声引导下腰椎脊神经后内侧支阻滞在治疗腰背痛临床实践中的可行性和有效性。方法:选取拟行腰椎脊神经后内侧支阻滞(medial branch block,MBB)的腰背痛病人64例。对所有病人行超声引导下腰椎L;-L;脊神经后内侧支阻滞,按照L;+L;脊神经后内侧支阻滞不同的阻滞技术,分为常规两针两点组(TT组)和改良一针两点组(OT组),每组32例。记录每例病人单侧操作需要时间,治疗前、治疗后1小时和治疗后2周的视觉模拟评分法(visual analogue scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI)评分;以治疗后2周VAS评分下降50%和ODI评分下降40%为治疗有效,计算单次治疗有效率,并记录治疗过程中和治疗后病人的不良反应。结果:所有病人均顺利完成超声引导下腰椎L;-L;脊神经后内侧支阻滞,OT组阻滞时间快于TT组(P<0.05),两组病人单次治疗后1小时和治疗后2周VAS评分和ODI评分均显著下降(P<0.05),OT组在治疗后1小时和2周VAS评分和ODI评分均低于TT组(P<0.05)。OT组和TT组病人单次治疗有效率分别为75%和47%(P<0.05)。OT组病人治疗期间和治疗后无明显不良反应,TT组2例病人在穿刺L;脊神经后内侧支阻滞过程中出现下肢神经刺激症状。结论:改良“一针两点法”有效解决了目前超声引导下L;脊神经后内侧支阻滞实践操作中存在的困难,短期内可显著改善腰背痛病人VAS评分和ODI评分,但还需大样本和长期随访研究进一步验证临床有效性和安全性。

Objective:To observe the clinical feasibility and efficacy of a modified approach of ultrasound-guided lumbar medial branch block in the treatment of low back pain.Methods:Sixty-four patients with low back pain were recruited to achieve ultrasound-guided lumbar medial branch block(MBB).Ultrasound-guided L;-L;MBB was proceeded for each patient.According to the technique to block the L;and L;medial branches,the patients were randomly allocated to two groups:the regular two-points via two punctures(TT)group,the modified twopoints via one puncture(OT)group,each group 32 cases.The performance time was recorded during the block treatment.The visual analogue scale(VAS)scores and the Oswestry disability index(ODI)scores before treatment,1 hour after treatment and 2 weeks after treatment were also recorded.The treatment was considered effective when VAS scores and ODI scores improved by 50%and>40%,respectively.The effective response rates were calculated 2 weeks after treatment.Results:All the L;-L;MBB performances were successfully finished under the ultrasound guidance.The time to complete the block in the OT group was shorter than that in TT group(P<0.05).Both VAS scores and ODI scores decreased significantly at 1 hour and 2 weeks after treatment for both groups compared with those before treatment(P<0.05),however VAS scores and ODI scores of the OT group were lower than those of the TT group(P<0.05).The effective response rates after a single treatment were 75%and 47%for OT group and TT group respectively(P<0.05).There were no obvious adverse reactions during and after treatment in the OT group,and two patients in the TT group developed lower limb nerve irritation during the L;MBB puncture.Conclusion:The modified ultrasound-guided"two-points via one puncture"approach solves the difficulties encountered in the practice of ultrasound-guided L;MBB and improves the VAS scores and ODI scores during the short-term observations.However,further studies with large sample and long-term observation are needed to validate its efficacy and safety.