改良经椎板间入路与传统入路治疗单节段腰椎椎管狭窄症的病例对照研究

目的:探讨改良经椎板间入路治疗单节段腰椎椎管狭窄症的临床疗效。方法:选取2015年2月至2017年8月拟行内窥镜下手术治疗的单节段腰椎椎管狭窄症患者80例,其中男38例,女42例;年龄33~69(47.6±9.5)岁。采用随机数字表法分为研究组和传统组各40例,分别采用改良经椎板间入路和传统入路手术治疗。记录两组患者的手术时间、术中出血量、住院时间;比较手术前后不同时间的疼痛视觉模拟评分(visual analogue scale,VAS),Oswestry功能指数(Oswestry Disability Index,ODI);观察椎管面积、椎管内径、盘黄间隙及手术并发症。结果:80例患者均获得3个月以上的随访。2例出现切口感染,均为传统组患者;两组患者的手术时间差异无统计学意义(P>0.05);术中出血量和住院时间研究组均低于传统组(P<0.05);术后1周,术后3个月两组患者的VAS评分、ODI指数均较术前明显降低(P<0.05),但组间差异无统计学意义(P>0.05);术后3个月研究组患者的椎管面积、椎管内径测定值均大于传统组(P<0.05)。两组手术并发症发生率差异无统计学意义(P>0.05)。结论:改良经椎板间入路手术在单节段腰椎椎管狭窄症患者治疗中较传统入路具有创伤更小、恢复更快、术后椎管间隙恢复更好的优势。

Case-control study on the treatment of single-segment lumbar spinal stenosis with modified interlaminar approach and traditional approach

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 L_2,3,8 cases at L_3,4,11 cases at L_4,5,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 L_2,3,6 cases at L_3,4,9 cases at L_4,5,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.