CT-guided suprascapular nerve blocks: a pilot study

Objective The objective of this study was to describe the suprascapular nerve block using CT guidance and to evaluate the short- and medium-term efficacy in a range of shoulder pathologies.Design and patients CT-guided infiltration around the suprascapular nerve was performed with bupivacaine and Celestone Chronodose on 40 consecutive patients presenting with chronic shoulder pathologies unresponsive to conventional treatment. Patients were interviewed using the Shoulder Pain and Disability Index (SPADI) before the procedure, 30 min after the procedure and at 3 days, 3 weeks and 6 weeks afterwards.Results Within 30 min of the block overall pain scores decreased from a mean (±SEM) pain score of 7.0 (±0.4) to 3.5 (±0.5) (n=39, P<0.001). At 3 days after the procedure, the mean overall improvement of the pain and disability scores were 20.4% (±4.9, P<0.001) and 16.8% (±4.8, P=0.004) respectively. Sustained pain relief and reduced disability were achieved in 10 of 35 (29%) patients at 3 weeks and longer. Patients suffering from soft tissue pathologies were the most likely patients to benefit from the injection. No serious side effects were noted.Conclusions In some patients with chronic soft tissue pathologies who do not respond to conventional treatment, a CT-guided suprascapular nerve block can provide safe short- and medium-term relief from pain and disability.     

腹腔镜腰交感神经节切除术的解剖学基础

目的 研究腰交感神经的局部解剖关系,为临床开展腹腔镜腰交感神经节切除术(VALLS)提供解剖学资料.方法 观察总结128侧成尸的腰部交感神经及其毗邻结构的解剖关系;回顾性分析13例VALLS.结果 (1)腰交感神经节数目每侧1～6个不等,以3～4个最多见,位置、形态变异较大;(2) 128侧中有12例发现腰交感干节间支分裂,占9.38%;(3)腰动脉均位于神经干的深面,腰静脉多位于腰交感干浅面,占68.42%±4.35%;(4)生殖股神经穿出腰大肌平面,多数与L2～L4椎体或椎间盘对齐,穿出点距腰大肌内侧缘0.81±0.48cm;(5)输尿管髂血管交界处距腰大肌外缘距离:左侧为3.36±0.59cm,右侧为3.41±0.59cm.(6)13例VALLS手术时间2～3.5h,术中出血50～80ml,术中术后未出现严重并发症,手术效果良好.结论 腰交感神经变异较大,毗邻结构关系复杂;腹腔镜腰交感神经节切除术成功的关键是掌握良好的腹腔镜操作技巧,熟悉腰交感神经的局部解剖关系,术中认真仔细的操作.     

Cervical CT-guided, selective nerve root blocks: improved safety by dorsal approach

Cervical transforaminal blocks are frequently performed as a treatment of cervical radicular pain. These blocks are performed mostly under fluoroscopy, but a CT-guided technique also has been described. We describe a modification that leads to a more extraforaminal than transforaminal and equally selective nerve root block.     

CT-guided percutaneous biopsy of thoracic and lumbar spine: A new coaxial technique

Herein we describe the technique of CT-guided lumbar or thoracic bone biopsy performed with a larger bore needle and coaxial system. The use of the external sheath cannula as a coaxial system led to an accurate diagnosis in all 19 patients who underwent the procedure. Bleeding at the biopsy site occurred in two patients and was controlled by insertion of Gelfoam. No other complications were encountered. We suggest that our procedure is more effective, reliable, safe, and rapid than the traditional technique.     

Potential of a new laser target system for percutaneous CT-guided nerve blocks: technical note

A prototype of a laser target device was used for CT-guided nerve blocks in a preliminary series of nine interventions. The system provides guidance from any possible approach. High accuracy of needle insertion was achieved; the average deviation of the planned from the actual angle was 1.4°. The target device is valuable for facilitating minimally invasive therapy and can decrease the time required for the procedure. Received: 31 January 2000 Accepted: 8 April 2000     

Value of CT fluoroscopy for lumbar facet blocks

We compared the diagnostic accuracy of lumbar facet blocks guided by either conventional fluoroscopy or CT fluoroscopy (CTF). Seventy-one blocks were performed with conventional fluoroscopy, and 58 were performed using CTF. Pain scores were measured before and after the procedure. The CTF group had a greater percentage decrease in pain (79.5% +/- 31.1%) than did the conventional fluoroscopy group (55.5% +/- 38.0%; P < .0005). We conclude lumbar facet blocks by using CTF guidance results in greater diagnostic accuracy than do conventional fluoroscopy.     

CT导向下O2～O3混合气体注射治疗腰椎间盘突出

目的:观察CT导向下O2～O3混合气体注射治疗腰椎间盘突出症的疗效.方法:腰椎间盘突出症患者20例,在CT引导下向突出椎间盘内注入60ug/ml O2～O3混合气体15～35ml,在椎间孔内注入40 ug/ml O2～O3混合气体5～10ml及得保松1ml 弥可保2ml混合液.术后3个月随访,疗效评定分为显效、有效和无效.结果:臭氧在椎间盘内呈髓核腔内积聚状、裂隙状、弥散状分布.显效率为 40%(8/20),有效率为30%(6/20).结论:CT导向下O2～O3混合气体椎间盘注射具有定位准确、微创、疗效显著、并发症少等优点,是治疗腰椎间盘突出的有效手段.     

Midterm results of percutaneous CT-guided aspiration of symptomatic lumbar discal cysts

OBJECTIVE: Lumbar intervertebral discal cysts are rarely reported. To our knowledge, only 12 cases have been reported in the literature. The symptoms are indistinguishable from those of typical discal herniation. Our aim is to report the imaging characteristics, method of percutaneous CT-guided aspiration, and clinical outcome after management of lumbar intervertebral discal cysts. CONCLUSION: Percutaneous CT-guided aspiration is an effective method for the management of lumbar intervertebral discal cysts.     

CT导引下椎间孔镜治疗腰椎间盘突出症的CT评价

目的：探讨 CT 检查对评价 CT 导引下椎间孔镜(PTED)治疗腰椎间盘突出疗效的应用价值。方法回顾性分析经 PT-ED 治疗腰椎间盘突出症40例患者的 CT 图像,测量手术前、后突出椎间盘最大后移位距离、纵轴线长度、相应区域 CT 值和计算椎间隙高度维持率。使用日本骨科学会(JOA)下腰背痛的评分标准对术前、后患者进行评分。结果PTED 前、后突出椎间盘后移位距离、纵轴线长度、CT 值分别为：(6.19±1.44)mm、(9.10±2.59)mm、(64.06±10.00)HU 和(2.73±0.95)mm、(4.62±2.49)mm、(33.60±8.40)HU;JOA 评分分别为8.75±2.69、25.23±2.03,恢复率为80.69%±11.20%。3种 CT 测量值与 JOA 评分的相关性分析中决定系数 R 2=0.79、F =96.90、P 值=0.000。手术椎间隙高度术前、后分别为(4.91±0.49)mm、(4.57±0.46)mm,与 JOA 评分的相关性分析中决定系数 R 2=0.93、F =520.43、P 值=0.000,椎间距维持率93%±3%。结论术后 CT 检查能够有效评估 PT-ED 治疗腰椎间盘突出症疗效,且具有重要临床指导意义。     

CT引导下经皮穿刺活检术对胸腰椎疑难病变的诊断价值

目的 探讨CT引导下经皮穿刺活检术对胸腰椎疑难病变的临床诊断价值.方法 对临床及影像资料不能确诊的128例胸腰椎椎体病变患者行CT引导下经皮穿刺活检术,并做病变部位涂片细胞学检查,其中119例取出骨块或软组织标本送病理检查,19例抽取脓液或血液送细菌培养.结果 128例均成功取材,无并发症,穿刺诊断结果与最终临床诊断符合者107例,占83.6％.结论 CT引导下经皮穿刺活检创伤小,准确率高,对脊柱疑难病变的诊断及治疗方案的制订具有重要指导意义.     

五例原发性腰椎间盘炎的臭氧治疗分析

目的评价CT引导下用臭氧治疗腰椎间盘炎的临床价值。方法 2010年3月-2011年3月,对5例腰椎间盘炎患者进行CT引导下臭氧治疗。症状出现1～8个月,平均3个月。采用椎间盘后外侧入路,即安全三角入路,或小关节内侧入路。CT扫描确定针尖位于椎间盘中心后,缓慢注入臭氧过程中,观察患者的疼痛反应及CT监视臭氧分布情况,并注入治疗剂量的臭氧。结果 5例腰椎间盘患者均完成CT引导下用臭氧行治疗,采用Mac-Nab腰痛痛评价,5例均获显效。结论 CT引导下用臭氧行腰椎间盘炎的治疗是有效方法。缩短卧床时间,减少抗菌药物的使用。     

CT引导下椎间盘镜治疗椎间盘突出症的护理体会

椎间盘突出症是因椎间盘变性、纤维环破裂、髓核突出刺激或压迫神经根、马尾神经所表现的一种综合征。是骨科的常见病,多发病。     

CT引导下水针刀靶向微创治疗腰椎横突综合征临床研究

【摘要】 目的 探讨CT引导下水针刀靶向微创松解注射治疗腰椎横突综合征的疗效及安全性。方法 选取2017年1月至2019年4月就诊的腰椎横突综合征患者152例,随机分为观察组和对照组各76例。观察组采用CT引导下水针刀靶向微创松解注射治疗,对照组采用小针刀治疗。疗程结束3个月后采用总有效率来评定患者的治疗效果。采用Oswestry功能障碍指数（ODI）、JOA下腰痛评分、视觉模拟量表（VAS）评分对两组患者治疗前后的腰部功能障碍与疼痛程度进行评估,并比较治疗前后两组间差异。结果 治疗后观察组愈显率（治愈+显效）为76.4%,总有效率为94.4%,对照组愈显率为55.7%,总有效率为77.1%。与对照组相比,观察组的愈显率、总有效率更高（均P＜0.01）。治疗前两组患者ODI脊柱功能障碍总分、ODI、JOA下腰痛评分、VAS评分比较差异无统计学意义（均P＞0.05）。两组治疗后观察组ODI脊柱功能障碍总分、ODI、VAS评分与对照组比较下降更为显著（均P＜0.01）;JOA下腰痛评分与对照组比较提高更为显著（P＜0.01）。结论 采用CT引导下水针刀靶向微创松解注射技术治疗腰椎横突综合征疗效好,安全性高,患者痛苦小,对正常软组织的损伤少,是一种精准的微创介入治疗法。     

CT引导下选择性神经根注射治疗多节段腰椎间盘突出症的临床研究

目的 探讨CT引导下选择性神经根注射在多节段腰椎间盘突出症中明确责任节段及疗效评估中的作用.方法 33例多节段腰椎间盘突出症患者,在CT引导下对可疑责任节段进行选择性神经根注射治疗,以疼痛视觉模拟评分(VAS)、日本骨科协会(JOA)评分对患者治疗前后的症状进行评估.结果 选择性神经根注射术明确责任节段33例,其中单节段24例(72.7％),2节段9例(27.3％).26例(78.8％)患者术中疼痛症状再现,伴加重,7例(21.2％)患者术中疼痛症状再现,不伴加重.术后VAS评分,20例(60.6％)显著有效,8例(24.2％)中度有效,5例(15.2％)无效,总有效率占84.8％;JOA评分,改善率优8例(24.2％),良12例(36.4％),中5例(15.2％),差8例(24.2％),优良中率占75.8％.结论 CT引导下选择性神经根注射有利于明确复杂的腰椎间盘突出症的责任节段,具有良好的临床疗效,术中患者疼痛症状再现伴加重有利于术后疗效的预判.     

CT-guided epidural/perineural injections in painful disorders of the lumbar spine: Short- and extended-term results

Purpose: Evaluation of short- and extended-term results of repeated epidural/perineural injections (EDT/PRT) of corticoids in painful afflictions of the lumbar spine. Methods: Thirty-two patients who had persistent radicular or low back pain for more than 6 weeks were treated with CT-guided injection therapy. By EDT/PRT, 40 mg of triamcinolonacetonid was injected either periradicularly or by a direct intraspinal epidural method at intervals of 3 weeks. Altogether, 140 EDT/PRT were performed in 32 patients (mean 4.4, range 2–8). In nine patients partial facet joint denervation with 1–2 ml of 50% alcohol solution was combined with EDT/PRT to reduce low back pain. Before and after treatment and at follow-up (mean 9.6 months), treatment success was evaluated on a visual analog scale and by physical examination (good = >50% improvement, moderate = 20%–50%, no improvement = <20%). Results: Short-term (end of therapy) good or moderate improvement was achieved in 91% of patients, extended-term (mean 9.6 months) in 56%. Regarding certain subgroups, those with disc herniations of the lumbar spine showed a better outcome with good or moderate improvement in 95% short-term and 69% extended-term than those with spinal stenosis who had 72% short-term and 28% long-term. Conclusion: Results indicate that CT-guided EDT/PRT in combination with partial facet joint denervation is a safe and effective outpatient treatment.