DSA引导下选择性脊神经根阻滞治疗腰椎间盘突出症的临床研究

目的评价选择性脊神经根阻滞（SNRB）与椎旁神经阻滞（PVB）治疗腰椎间盘突出症的临床效果和安全性。方法选择60例腰椎间盘突出症引起腰腿痛的患者，随机分为DSA引导下选择性脊神经根阻滞组（A组）和椎旁神经阻滞组（B组），比较两组得宝松用量、局麻药混合液用量、加用镇痛药物15服情况。观察治疗前、治疗后14d疼痛VAS评分、临床有效率和不良反应。结果A组得宝松、局麻药混合液用量较B组少，加用镇痛药物比率A组比B组低，差异有统计学意义。治疗前两组的VAS评分差异无统计学意义，治疗后14dA组VAS评分优于B组，A组总有效率明显优于B组，差异有统计学意义。两组不良反应相比A组少于B组，差异有统计学意义（P〈0．05）。两组各有1例疼痛反复发作改手术治疗。结论DSA引导下选择性脊神经根阻滞目标性强、准确性高、安全、临床效果好，值得临床推广．而腰椎旁神经阻滞因盲目注药存在药物注入血管和神经根袖内的潜在危险。

Selective spinal nerve root block in treatment of lumbar disc herniation under DSA guidance

Objective To evaluate the clinical efficacy and safety of selective spinal nerve root block(SNRB) and paravertebral nerve block(PVB) in treatment of lumbar disc herniation.Methods Sixty cases of low back pain caused by lumbar disc herniation were randomly assigned to DSA under the guidance of selective spinal nerve root block(group A) and paravertebral nerve block(group B).The amount of Diprospan,local anesthetic mixture dosage,oral analgesic drugs of two groups were compared.VAS score,clinical efficiency and adverse reactions were observed before and 14 days after treatment.Results The amount of Diprospan and local anesthetic mixture in group A were less than in group B,and the differences were statistically significant;plus analgesic ratio in group A was lower than in group B,and the difference was significant.The difference of pre-treatment VAS score was not statistically significant,but after treatment 14 days,VAS score of group A was better than that of group B,and clinical efficiency of group A was also better than that of group B,the differences were statistically significant.Compared with group B,group A had less adverse reactions,and the difference was statistically significant(P < 0.05).Both groups had 1 case of patient with recurrent pain who changed to surgery.Conclusion DSA under the guidance of selective spinal nerve root block has safety and good clinical effect,is worthy of clinical promotion.