神经根注射激惹及其评分在判断腰椎间盘突出症责任病灶中的临床价值研究

Study on the clinical value of radicular injection provocation and its score in judging the responsible lesions of LDH

目的:评估神经根注射激惹(Radicular injection provocation,RIP)及其评分在判断腰椎间盘突出症(Lumbar disc herniation,LDH)责任病灶中的临床应用价值。方法:纳入2022年10月至2023年6月诊断为LDH(单节段椎管内Ⅰ~Ⅱ区突出)且拟行脊柱内镜手术患者120例。所有患者均于术前行椎管内神经根注射激惹(Intraspinal radicular injection provocation,I-RIP)、旁神经根注射激惹(Paravertebral radicular injection provocation,P-RIP)及椎间盘造影术。记录3种手术方法手术情况并分析、比较其灵敏度;记录3种手术方法诱发患者原有疼痛症状部位、强度、诱发所需剂量并进行赋值评分,比较其准确判断责任病灶的价值。结果:所有患者均顺利完成手术,未发现与研究相关并发症。I-RIP灵敏度(89.2%)高于椎间盘造影术(51.7%)及P-RIP(57.5%)(P<0.001)。与P-RIP和椎间盘造影相比,I-RIP诱发患者原有症状部位更加一致、诱发患者原有症状强度更强(P<0.05),I-RIP与P-RIP在激惹诱发部位、强度和所需剂量等方面得分差异有统计学意义(P<0.001);与P-RIP比较,I-RIP的得分更高,诱发症状部位与患者平时症状部位更一致、诱发疼痛强度更强、诱发所需剂量更低。结论:与椎间盘造影术相比,RIP具有更高的敏感性,可更准确判断LDH责任病灶。

Objective:To evaluate the clinical application value of radicular injection provocation(RIP)and its score in judging the responsible lesions of lumbar disc herniation(LDH).Methods:From October 2022 to June 2023,120 patients diagnosed with LDH(single-segment intraspinalⅠ~Ⅱherniation)and scheduled for spinal endoscopic surgery were included.All patients underwent intraspinal(lesion target),paravertebral(same segment non-lesion target)radicular injection provocation and discography before surgery.The data of the surgery of the 3 techniques were recorded and analyzed,and the sensitivity was compared.The original pain symptom location,intensity,induced dose and visual analogue scale(VAS)score of the 3 techniques were recorded and compared,and the value of the 3 techniques in accurately judging the responsible lesion was evaluated.The observation indexes of irritability were preliminarily explored and scored,and the differences between the scores of the lesion target and the non-lesion target were compared.Results:All the patents completed the surgery successfully,and no related complication were found.The sensitivity of intraspinal RIP(89.2%)was significantly higher than that of discography(51.7%,P<0.001)and paravertebral RIP(57.5%,P<0.001).Compared with paravertebral RIP at non-lesion sites,the score of intraspinal RIP was higher,the site of inducing symptoms was more consistent with the patient's usual symptom site,the intensity of inducing pain was stronger,and the required dose of inducing pain was lower(P<0.05).The difference between intraspinal RIP and paravertebral RIP in the scores of irritating sites,intensity and required dose was statistically significant(P<0.001).Conclusion:Compared with discography,RIP has higher sensitivity and can more accurately determine the responsible lesions of LDH.