摘要
目的探讨选择性神经根阻滞联合椎间孔入路经皮脊柱内镜手术治疗腰椎退行性疾病的疗效及临床意义。方法回顾性分析自2018-01—2019-05诊治的影像学检查结果显示病变节段与临床表现不一致的42例腰椎退行性疾病,先进行选择性神经根阻滞明确责任节段,然后精准实施椎间孔入路经皮脊柱内镜手术。结果42例进行选择性神经根阻滞后明确了单一责任节段,责任节段:L_(2、3)2例,L_(3、4)2例,L_(4、5)30例,L5S18例。椎间孔入路经皮脊柱内镜手术中均未出现神经根及硬膜囊损伤,术后患者腰腿痛症状明显缓解。42例均获得随访,随访时间平均20.1(13~29)个月。末次随访采用改良MacNab标准评定临床疗效:优38例,良1例,可3例。术后第3天疼痛VAS评分较术前明显降低,差异有统计学意义(P<0.05)。术后3个月JOA评分与ODI指数较术前明显改善,术后6个月持续改善,差异有统计学意义(P<0.05)。结论对于临床表现与影像学结果不相符的多节段腰椎退行性疾病患者,可以先进行选择性神经根阻滞,确定导致临床症状的责任节段后再进行经皮脊柱内镜手术治疗,进而有效缓解患者症状并提高其生活质量。
Objective To investigate the efficacy and significance of selective nerve root block combined with percutaneous spine endoscopic surgery by transforaminal approach in the treatment of lumbar degenerative diseases.Methods Fortytwo patients of lumbar degenerative disease from January 2018 to May 2019 were retrospectively analyzed,whose imaging examina-tion results showed different lesion segments with the clinical manifestations.The selective nerve root block was performed first to identify the responsible segment,followed by the accurate implementation of intervertebral foramen approach endoscopic surgery.ResultsAfter the selective nerve root block,the single responsible segment of 42 patients was identified:L_(2,3)in 2 cases,L_(3,4)in 2 cases,L_(4,5)in 30 cases,L_(5)S_(1)in 8 cases.No injury of nerve root and dural sac occurred.The lumbar and leg pains were significantly relieved after operation.All 42 patients were followed up,for average follow-up time of 20.1 months(13-29).At the last followup the modified MacNab criteria was used to assess the clinical curative effect:excellent in 38 cases,good in 1 case,fair in 3 cases.The pain VAS score on the third day after operation was significantly lower than that before operation,the difference was statistically significant(P<0.05).The JOA score and ODI index on the 3 months after operation obviously improved compared with those before operation and the improvement continued 6 months after operation,the difference was statistically significant(P<0.05).Conclusion For the patients of multiple segmental lumbar degenerative disease whose imaging examination results show different lesion segments with their clinical manifestations,the selective nerve root block can be conducted first to determine the responsible segment and then the percutaneous spine endoscopic surgery is performed to effectively relieve patients'symptoms and improve their quality of life.
作者
胡铜
田峰
张恩丰
单烁
赵疆
涂来勇
HU Tong;TIAN Feng;ZHANG Enfeng;SHAN Shuo;ZHAO Jiang;TU Laiyong(The Fourth Clinical Medical College of Xinjiang Medical University,Urumqi,Xinjiang 830000,China;不详)
出处
《中国骨与关节损伤杂志》
2023年第5期467-470,共4页
Chinese Journal of Bone and Joint Injury
关键词
腰椎退行性疾病
神经根阻滞
经皮脊柱内镜
椎间孔入路
Lumbar degenerative disease
Nerve root block
Percutaneous transforaminal endoscopy
Transforaminal approach
