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超声引导下经颈椎椎间孔行硬膜外腔阻滞对神经根型颈椎病患者的疗效观察
Efficacy Of Ultrasound-guided Cervical Transforaminal Epidural block On The Treatment Of Cervical Radiculopathy?
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DOI:
作者:
施海峰,张昕,吕莹莹,浦少锋,徐永明,周瑾,杜冬萍
SHI Hai-Feng, ZHANG Xin, LV Yin-Yin, PU Shao-Feng, XU Yong-Ming, ZHOU Jin, DU Dong-Ping
作者单位:
同济大学医学院 上海市第一人民医院分院麻醉科 上海交通大学附属上海市第六人民医院疼痛中心
Tongji university of medicine,Shanghai Department of Anesthesiology ,Branch of Shanghai First People’s Hospital Department of Pain Management Center,Shanghai Sixth People’s Hospital
关键词:
超声;椎间孔;硬膜外阻滞;神经根型颈椎病
Ultrasound; Cervical Transforaminal; Epidural block; cervical radiculopathy
摘要:
目的:探讨超声引导下经颈椎椎间孔行硬膜外腔阻滞技术的可行性、安全性和有效性。方法:选择2014年4月-2015年4月在上海市第六人民医院疼痛科确诊为神经根型颈椎病的60例患者,采用随机数字表法,随机分为超声引导下经颈椎椎间孔行硬膜外腔阻滞组(C组,n=30)和超声引导下颈神经根阻滞治疗组(S组,n=30)。记录患者术前1天、术后30分钟、术后2周、术后4周、术后8周的疼痛视觉模拟评分(visual analogue scale,VAS);记录两组治疗后并发症发生率;记录两组治疗次数≥ 2的例数;记录两组注射造影剂后颈神经根和颈椎硬膜外腔显影情况,以及实时监测造影剂血管内注射情况;记录两组术后8周仍需服用药物控制疼痛的患者例数。结果:与治疗前相比,两组治疗后各时点VAS评分均明显降低。两组术后30min的VAS评分无明显差异,C组术后2周,4周,8周的VAS低于S组(P < 0.01);两组不良反应发生率无明显差异;S组治疗次数明显多于C组,C组8周后仍需服用药物例数明显少于S组(P < 0.01);两组注射造影剂后神经根显影情况以及血管内注射情况无统计学意义,但C组有23例硬膜外腔显影较好,S组无一例显影。结论:超声引导下经颈椎椎间孔行硬膜外腔阻滞技术是一种可视化、安全、有效的治疗技术。
Objective: To evaluate the feasibility, safety and effectiveness of ultrasound-guided cervical transforaminal epidural block on the treatment of cervical radiculopathy. Methods: A total of 60 patients with cervical radiculopathy diagnosed in the Pain Management Center of Shanghai Sixth people's Hospital were randomly divided into 2 groups: the cervical transforaminal epidural block group (group C, n=30) and the selective nerve root block group(group S, n=30). Visual analogue scale (VAS) was recorded at 1 day before treatment and 30mins, 2 weeks, 4 weeks and 8 weeks after treatment; Incidence of adverse reactions was also recorded after treatment; Cases with treatment times ≥ 2 were also recorded. The spread of contrast agent to the nerve root and epidural space after injection was recorded, vascular injection was real-time monitored. Cases taking analgesics to control pain at 8 weeks after treatment were recorded. Results: After treatment, VAS in the two groups was significantly lower than that before treatment. VAS at 2 weeks, 4 weeks and 8 weeks after treatment was significantly lower in the group C as compared to that in the group S (P< 0.01), although there was no difference at 30mins after treatment between the two groups. There was no significant difference in the incidence of adverse reactions between the two groups. The treatment times in the group S was significantly more than that in the group C.Number of patients still need to take analgesics in group C was less than those in the group S (P< 0.01). There was no difference in the nerve root development and intravascular injection after injection of contrast agent between the two groups. However, there were 23 cases in the group C that the contrast agent spread to epidural space, while there was no contrast agent spread to epidural space in the group S. Conclusion: The ultrasound-guided cervical transforaminal epidural block is a visualized, safe and effective treatment on the cervical radiculopathy.
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