| 超声引导下选择性神经分支阻滞在腰脊神经后支综合征中的应用 |
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投稿时间：2020-07-17
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| 作者 | Author | 单位 | Address | E-Mail |
| 许运章 |
XU Yun-zhang |
柳州市中医医院麻醉科, 广西 柳州 545006 |
Department of Anesthesiology, Liuzhou Traditional Chinese Medicine Hospital, Liuzhou 545006, Guangxi, China |
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| 苏明 |
SU Ming |
柳州市中医医院麻醉科, 广西 柳州 545006 |
Department of Anesthesiology, Liuzhou Traditional Chinese Medicine Hospital, Liuzhou 545006, Guangxi, China |
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| 冯鹏玖 |
FENG Peng-jiu |
柳州市中医医院麻醉科, 广西 柳州 545006 |
Department of Anesthesiology, Liuzhou Traditional Chinese Medicine Hospital, Liuzhou 545006, Guangxi, China |
smtg2018@163.com |
| 邓莉华 |
DENG Li-hua |
柳州市中医医院驻第一看守所医务科, 广西 柳州 545005 |
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| 期刊信息：《中国骨伤》2021年，第34卷，第4期，第341-346页 |
| DOI：10.12200/j.issn.1003-0034.2021.04.009 |
| 基金项目:广西壮族自治区卫生和计划生育委员会自筹经费科研课题（编号：Z2015208） |
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中文摘要:
目的： 探讨超声引导下选择性神经分支阻滞在腰脊神经后支综合征中的临床疗效与安全性。
方法： 选择2017年5月至2018年12月在疼痛科门诊收治的腰脊神经后支综合征患者40例，根据神经阻滞定位方法将患者分为超声引导组和解剖定位组，每组20例。解剖定位组患者男7例，女13例，年龄（63.42±7.71）岁，体重（63.65±10.72） kg，数字疼痛强度量表（numerical rating scale，NRS）评分（6.61±1.52）分，病程（16.55±4.68）个月。疼痛部位：L2，3节段4例，L3，4节段8例，L4，5节段11例，L5S1节段11例。超声引导组男10例，女10例，年龄（59.58±10.21）岁，体重（60.61±13.81） kg，NRS评分（6.84±2.43）分，病程（13.70±5.98）个月。疼痛部位：L2，3节段6例，L3，4节段6例，L4，5节段9例，L5S1节段13例。超声引导组患者使用超声引导下选择腰脊神经后内侧支与后外侧支行神经阻滞，解剖定位组使用解剖定位法行腰脊神经后内侧支与后外侧支神经阻滞，注射药物均为0.125%罗哌卡因，每个神经分支注射3 ml。记录两组患者的治疗次数和每次治疗过程中俯卧位的时间以及治疗结束后即刻、1周、2周、1个月、3个月的NRS评分，并观察治疗过程中局麻药过敏与中毒、局部穿刺感染、全脊髓麻醉等不良事件和头晕、嗜睡、恶心、呕吐等不良反应的发生情况。
结果： 两组患者在性别、年龄、体重、NRS评分、病程及疼痛节段分布差异均无统计学意义（P>0.05）。解剖定位组所需要的治疗次数显著性高于超声引导组（P<0.000 1）。每次治疗期间患者俯卧位时间解剖定位组显著性低于超声引导组（P<0.000 1）。治疗结束后即刻、1周、2周、1个月、3个月的NRS评分：解剖定位组分别为（2.98±0.25）、（3.04±0.38）、（3.37±0.47）、（3.42±0.85）、（3.50±0.43）分，超声引导组分别为（2.94±0.31）、（3.00±0.29）、（3.21±0.68）、（3.16±0.94）、（3.17±0.53）分，在治疗结束后1个月和3个月时两组的NRS评分比较差异有统计学意义（P<0.05）。两组患者均未出现局麻药过敏与中毒、局部穿刺感染、全脊髓麻醉等不良事件，也没有发生嗜睡、恶心、呕吐等不良反应。在解剖定位组发生头晕6例，超声引导组12例，两组比较差异有统计学意义（P<0.05）。
结论： 相比解剖定位，超声引导下选择性神经分支阻滞治疗腰脊髓后支综合征可减少治疗次数，维持更长疗效时间，但也需关注每次治疗时间，以免引起头晕等不良反应。 |
| 【关键词】超声检查 神经传导阻滞 脊神经根 治疗结果 |
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| Application of ultrasound-guided selective nerve branch blockage in lumbar spinal nerve posterior branch syndrome |
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ABSTRACT
Objective: To investigate the efficacy and safety of ultrasound-guided selective nerve branch blockage in the treatment of lumbar spinal nerve posterior branch syndrome.
Methods: A total of 40 patients with lumbar spinal nerve posterior branch syndrome treated by Pain Clinic from May 2017 to December 2018 were selected. According to the method used in locating site for nerve blockage,the patients were divided into ultrasound-guided group and anatomical positioning group,with 20 cases in each group. In anatomical positioning group,there were 7 males and 13 females,aged (63.42±7.71) years old,weighted (63.65±10.72) kg,numerical rating scale (NRS) was (6.61±1.52) scores,course of disease was (16.55±4.68) months. Pain sites:4 cases at L2,3,8 cases at L3,4,11 cases at L4,5,and 11 cases at L5S1. In ultrasound-guided group,there were 10 males and 10 females,aged (59.58±10.21) years old,weighted (60.61±13.81) kg,NRS was(6.84±2.43) scores,and course of disease was(13.70±5.98) months. Pain sites:6 cases at L2,3,6 cases at L3,4,9 cases at L4,5,and 13 cases at L5S1. Ultrasound-guidedgroup used ultrasound-guided selective posteromedial branch and posterolateral branch nerve blockage,and the anatomical positioning group used anatomical localization method to block the posteromedial branch and posterolateral branch of lumbar spinal nerve. Each nerve branch was injected 3 ml of 0.125% ropivacaine. The number of treatment required and prone position time of each treatment were recorded,and the NRS scores of patients at the time points of immediately after the end of the treatment,the first week,the second week,the first month and the third month were evaluated. And adverse events such as local anesthetic allergy and poisoning,local puncture infection,total spinal anesthesia,dizziness,drowsiness,nausea,vomiting and other adverse reactions were observed.
Results: There were no statistically significant differences in gender,age,weight,NRS,course of disease and pain segment distribution between two groups(P>0.05). The number of treatment required in anatomical positioning group was significantly higher than that in ultrasound-guided group(P<0.000 1). During each treatment,the time in the prone position of the patients in anatomical positioning group was significantly lower than that in ultrasound guided group(P<0.000 1). NRS scores immediately after the end of treatment,1 week,2 weeks,1 month and 3 months,anatomical positioning group were 2.98±0.25,3.04±0.38,3.37±0.47,3.42±0.85,3.50±0.43,respectively,2.94±0.31,3.00±0.29,3.21±0.68,3.16 ±0.94,3.17±0.53 in ultrasound-guided group,and there was significant difference at 1 month and 3 months between two groups(P<0.05). There were no adverse events such as local anesthetic allergy and poisoning,local puncture infection,and total spinal anesthesia,and no adverse reactions such as lethargy,nausea,and vomiting occurred in two groups. There were 6 cases of dizziness in anatomical positioning group and 12 cases in ultrasound-guided group. The difference between two groups was statistically significant(P<0.05).
Conclusion: Compared with anatomical positioning,ultrasound-guided selective nerve branch block for the treatment of posterior branch of the lumbar spinal cord syndrome can reduce the number of treatments and maintain a longer therapeutic effect,but it is also necessary to pay attention to the time of each treatment to avoid dizziness and other adverse reactions. |
| KEY WORDS Ultrasonography Nerve block Spinal nerve roots Treatment outcome |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 许运章,苏明,冯鹏玖,邓莉华.超声引导下选择性神经分支阻滞在腰脊神经后支综合征中的应用[J].中国骨伤,2021,34(4):341~346 |
| 英文格式: | XU Yun-zhang,SU Ming,FENG Peng-jiu,DENG Li-hua.Application of ultrasound-guided selective nerve branch blockage in lumbar spinal nerve posterior branch syndrome[J].zhongguo gu shang / China J Orthop Trauma ,2021,34(4):341~346 |
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