脊柱源性腰腿痛腰骶丛药物灌注治疗疗效观察

目的探讨采用骶丛药物灌注方法治疗脊柱源性腰退痛的机理和临床价值.方法对475例脊柱源性腰腿痛患者,根据具体的发病原因、发病部位和病变范围,分别以骶管封闭、硬膜外封闭和脊神经后支阻滞的方法为主进行综合性治疗.结果采用骶管封闭治疗278例,有效率为93.5%.硬膜外封闭治疗治疗161例,有效率为93.2%.脊神经后支阻滞治疗牵涉性腰腿痛36例,有效率为97.2%.总有效率达93.7%.结论神经周围组织炎症并受到机械性刺激才是造成腰腿痛的主要病理机制针对神经周围化学性炎症,采用骶管封闭、硬膜外封闭和脊神经后支阻滞方法将药物直接注入病变部位,起到消炎、镇痛和剥离粘连的治疗作用,正确选择适应症、治疗方法和准确定位是取得满意疗效的关键.但强调对有神经机械性压迫为主,造成神经功能损害的患者,疼痛学治疗并不能完全替代牵引和手术仍需进行适当的病因学治疗.

Investigate the mechanism amd Ginic value of the treatmant of nerve analgeria forLumbocruret Pain of spine

To investigate the mechanism and the therapeutic effect of lumbosacral plexus block in the treatment of lumbosacral pain of spinal origin. Methods: 475 patients with lumbocrural pain were dividedinto 3 groups according to the causes, locations and the extents of the diseases. Croup 1(n = 278) treated by sacral peridural block; Group 2(n = 161) treated by lumbar peridural block; Group 3 (n = 36) treated by blockade of the posterior branch of the spinal nerve.Results: The effective rates in different groups were 93. 5%, 93. 2% and 97. 2% respectively, The overall effective rate was 93. 7%. Conciusions: The inflammatory reactions occurred in the tissues around the nerve and its mechanical stimulations were the primary pathologic mechanisms causing lumbocrural pain. peridural and spinal nerve blockade may act as an antiinflammatory, analgesic as well as an- tifibrotic action. it shouldbe emphasized that if the nerve is injured solely by mechanical compression, traction and surgery but not analgesic tnerapy are advocated.