超声引导与放射引导颈椎选择性神经根阻滞治疗神经根型颈椎病患者的疗效比较

Comparison of efficacy between ultrasound-guided and radiation-guided cervical selective nerve root block for treatment of cervical spondylotic radiculopathy

目的研究超声引导下颈椎选择性神经根阻滞治疗神经根型颈椎病的安全性和有效性,并与放射引导法相比较。方法收集苏北人民医院疼痛科2019年7月至2020年12月收治的神经根型颈椎病患者80例,采用随机数字表法分为放射引导组和超声引导组,每组各40例,均实施选择性颈神经根阻滞治疗,并根据患者疼痛缓解状况治疗2~4次,每2次间隔1周时间。观察并记录治疗前,治疗后1、2、4和8周时疼痛视觉模拟评分(VAS);记录神经根注射/阻滞区域相吻合的例数、治疗次数≥2次的患者例数;记录经治疗后4、8周时疗效评定及不良反应的发生情况。结果治疗前,两组患者VAS评分相比较,差异无统计学意义(P>0.05);与治疗前相比较,两组治疗后各时点VAS<4分患者例数明显增多,差异具有统计学意义(P均<0.05)。对于两组神经根注射/阻滞区域吻合例数,治疗次数≥2患者例数比较,差异无统计学意义(P均>0.05)。治疗后放射引导组2例患者发生局部血肿,超声引导组未见患者发生局部血肿。结论超声可视化技术等同于放射可视化引导的颈神经根阻滞治疗效果,且相关合并症更少。

Objective To evaluate the efficacy and safety of ultrasound-guided or radiology-guided selective cervical nerve root block in the treatment of cervical spondylotic radiculopathy.Methods Eighty patients with cervical spondylotic radiculopathy,in the Department of Painology of Subei People's Hospital from July 2019 to December 2020,were randomly divided into radiation-guided group,and ultrasound-guided group,forty cases in each group.Selective cervical nerve root block was performed for 2 to 4 times according to the patient's pain relief status and with one week interval.Visual analogue scale(VAS)was observed before the treatment,and 1 week,2 weeks,4 weeks,and 8 weeks after the treatment.The number of cases with consistency of nerve root injection site and block area and the number of cases with treatment times≥2 were also recorded.The efficacy evaluation and adverse reactions were also recorded at 4 and 8 weeks after the treatment.Results Before the treatment,there was no significant difference in VAS between the two groups(P>0.05).The number of cases with VAS<4 were increased significantly in the two groups at each time point after the treatment(all P<0.05).There was no significant difference between the two groups in the cases with consistency of nerve root injection site and block area,and the number of cases with treatment times≥2(all P>0.05).After the treatment,the patients showed no local hematoma in the ultrasound-guided group,while 2 cases in radiation-guided group.Conclusion The efficacy of ultrasound visualization technique is equivalent to that of radiation-guided cervical nerve root block in the treatment of cervical spondylotic radiculopathy,with fewer complications and without radiation hazard.