选择性脊神经根阻滞治疗盘源性坐骨神经痛

目的观察选择性神经根阻滞治疗盘源性坐骨神经痛的临床效果和安全性。方法选择伴有明显腿部放射痛或腿痛重于腰痛的腰椎间盘突出症患者41例,在斜位透视影像监测下,选用22G腰穿针,经椎弓根的外下方行腰脊神经根穿刺术,当患者出现与平时相似的腿部放射痛,造影剂试验显影充盈的神经根袖时,每1神经根注入1～2．5 ml阻滞液(2％利多卡因2 ml 复方倍他米松1 ml 0．9％生理盐水1 ml)。结果治疗后3日、3个月VSA评分均较治疗前明显降低(P<0．05),直腿抬高试验较治疗前明显提高(P<0．05),治疗后3日和3个月时的治疗优良率分别是80．49％(33例)和73．17％(30例)。治疗后未发现明显的并发症。结论选择性腰骶脊神经根阻滞能迅速缓解腰椎间盘突出症引起的根性坐骨神经痛,具有穿刺准确、靶位注射、药物集中、疗效确切和并发症少等优点。

Selective spinal nerve root block for treating discogenic sciatica

Objective To investigate the efficacy and safety of selective spinal nerve root block for treating discogenic sciatica. Methods 41 patients with lumbar disc hemiation and severe radiated leg pain or leg pain more than low back pain were selected. Under oblique angle fluoroscopic guidance, a 22 gauge, 6-inch spinal needle was penetrated just inferior and lateral to the pedicle. Radicular pain as similar to the usual was induced. 1-2.5 ml mixture block solution (2% lidocaine 2 ml compound betamethasone 1 ml 9% saline 1 ml) was injected into each nerve sheath after ideal needle location was identified by injecting contrast test. Results The VAS scales and Straight leg raising test (SLRT) between pre-treatment and post-treatment had significant improvement (P <0. 05). The excellent-good rate of therapy at day 3 and month 3 was 80.49% (33 cases) and 73. 17% (30 cases) respectively. There were no serious complications after the treatment. Conclusion selective lumbosacral spinal nerve root block can relieve discogenic sciatica quickly and safely, which has the advantages of accurate puncture, target injection, medication accumulating on pathological tissue, good therapeutic effect and very few side effects.