应用神经阻滞方法验证臀上皮神经卡压综合征存在另一卡压点

Another trigger point in the superior clunial nerve entrapment syndrome confirmed by diagnostic nerve blocking

目的通过试验性神经阻滞的方法证实臀上皮神经卡压除了存在入臀点的卡压外,还存在椎后关节处的卡压。方法对34例臀上皮神经卡压综合征患者进行神经阻滞以分析卡压点。首先阻滞臀上皮神经在髂嵴入臀点处,10min后患者自行评定疼痛缓解明显列为A组;余患者再次对L1～2、L2～3的患侧椎后关节外侧阻滞脊神经后支,10min后评定疼痛缓解明显列为B组;仍不明显者列为C组。记录可能造成臀上皮神经卡压的各种体征,其中小关节紊乱的体征包括棘突偏斜、条索状韧带剥离硬结、棘突侧方压痛等;入臀点处的体征包括入臀点压痛、入臀点附近皮下痛性硬结。盲法统计分析各组患者的性别、年龄、病史和体征。结果18例患者仅阻滞臀上皮神经在髂嵴入臀点则疼痛明显缓解,提示臀上皮神经卡压点位于该点或该点以下(归为A组)。12例患者需要对椎后小关节部位阻滞后疼痛才明显缓解,证实椎后关节存在另一卡压点(归为B组)。4例患者疼痛仍无明显缓解,推测可能卡压点仍存在于椎后关节以上如椎间孔处,或者脊神经后支的阻滞不完全所至(归为C组)。A组与B组之间年龄、性别、病史无显著性差异,B组具有关节紊乱的体征较A组明显为多(P<0.01)。结论椎后关节紊乱可以造成脊神经后支卡压,也是造成臀上皮神经卡压的因素。

Aim To confirm the existence of another trigger point crossing facet in the superior clunial nerve entrapment syndrome by diagnostic nerve blocking. Methods Thirty four patients suffering unilateral low back pain projecting in the territory of the superior clunial nerves were first injected with lidocaine at the posterior iliac crest cross site, and to evaluate the pain relief after 10min. The patients with satisfactory pain relief were used as group A; the patients with no satisfactory second blocked the dorsal ramus over the ipsilateral L1? 3 facet joints, then with satisfactory result were used as group B; the others with no satisfactory were used as group C. In each group, age, gender, course history and physical sign were recorded to statistics in results by blind method, and the sign included pain at iliac crest crossing site and the sign of facet joint syndrome included facet pain, ipsilateral soft tissue beside spine harden and pain, interspinal ligaments pain and other early disturbance sign. Results Eighteen patients obtained great relief from iliac crest injection were dividory into group A, 12 patients satisfactory pain relief after injection over facet joint were into group B, 4 cases no pain relief into group C. group A cases may have a trigger point over iliac crest just like pre report, but B group patients must have another point crossing the facet joint. The cases have the sign of facet joint syndrome in group B is more than in group A( P< 0.01) , there no statistics difference in ages, gender and course history. Group C no pain relief rest with two reasons, one is that trigger point still above the facet joint such as , another is that not completely block the dorsal ramus. Conclusion It is indicated that dorsal ramus may be pulled due to the dislocation of the facet joint, and the facet joint syndrome is one reason of entrapment on superior clunial nerve.<P>