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超声引导下选择性颈神经根阻滞治疗颈神经根痛：局麻药联合神经妥乐平或类固醇的随机对照研究
Ultrasound-guided selective cervical nerve root block for cervical radicular pain: a randomized controlled trial of anesthetic combination with neurotropin or steroid

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DOI:
作者:
石潇
作者单位:
上海交通大学医学院附属仁济医院
关键词:
颈神经根痛；类固醇；神经妥乐平；超声引导；视觉模拟量表；颈部残疾指数；SF-36
cervical radicular pain; steroid; neurotropin; ultrasound-guided; Visual Analog Scale; Neck Disability Index; SF-36.
摘要:
背景：选择性颈神经根阻滞（SCNRB）是一种安全有效的临床治疗颈神经根痛的方法。神经妥乐平是一种来自接种牛痘病毒的兔子发炎皮肤的非蛋白质提取物，已被用于治疗神经病理性疼痛。然而，神经妥乐平治疗神经病理性疼痛的临床效果仍存在争议。 目的：在这项前瞻性研究中，我们研究了神经妥乐平和类固醇在超声引导下选择性神经根阻滞治疗中的临床效果。 方法：自2015年1月至2017年12月对所有诊断为颈神经根疼痛的120名患者进行随机分组，分别接受超声引导下颈神经根的类固醇或神经妥乐平注射治疗。10分视觉模拟量表（VAS）用于测量疼痛强度，颈部残疾指数（NDI）测量疼痛残疾，SF-36健康状态量表用于评估患者的健康相关的生活质量。在治疗前和治疗后3、6和12个月评估结果。 结果：共纳入103例颈神经根痛患者。与基线相比，选择性神经根阻滞治疗后3、6、12个月，类固醇注射组和神经妥乐平注射组的VAS和NDI评分均较低，P值<0.01。两组的SF-36健康状况量表评分也显示与基线相比显著增加。组间分析显示两组之间无差异。两组均未出现严重并发症。
Background: Selective cervical nerve root block (SCNRB) is a safe and effective treatment for cervical radicular pain clinically. Neurotropin, a non-protein extract from the inflamed skin of rabbits inoculated with vaccinia virus, has been used in the management of neuropathic pain. However, the clinical curative effects of neurotropin for treating neuropathic pain remain controversial. Objective: In this prospective study, we investigated the clinical curative effect of neurotropin and steroid in the treatment of ultrasound-guided selective nerve root block. Methods: All the patients diagnosed of cervical radicular pain were reviewed during January 2015 to December 2017. Patients received steroid or neurotropin injections were compared with each other. The 10-point Visual Analog Scale (VAS) was used in measuring the pain intensity, while we applied the Neck Disability Index (NDI) to measure the pain disability, and the SF-36 health status scale to evaluate health-related quality of patients’ life. Outcomes were assessed prior to the treatment and at 3, 6, and 12 months after the treatment. Results: A total of 103 patients with cervical radicular pain were included in the study. Both VAS and NDI scores in the steroid injection group and neurotropin injection group were lower at 3, 6, 12 months after selective nerve root block treatment, compared to the baseline, with a P value <0.01. SF-36 health status scale score in the two groups also showed significantly increase compared to the baseline. Group-level analysis showed no difference between the two groups. No severe complications were associated with the two groups. Conclusion: Neurotropin showed a similar clinical curative effect with steroid in the treatment of ultrasound-guided selective nerve root block.

 

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