南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (12): 1804-1809.doi: 10.12122/j.issn.1673-4254.2020.12.16

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经椎间孔硬膜外阻滞术治疗腰痛伴神经根性疼痛

何玉宝，陈 蕾，徐执扬，王洁颖，刘 波   

  • 出版日期:2020-12-20 发布日期:2020-12-28

Lumbar transforaminal epidural block for treatment of low back pain with radicular pain

  • Online:2020-12-20 Published:2020-12-28

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摘要： 目的 评价经椎间孔硬膜外阻滞术（LTEB）治疗腰痛伴神经根性疼痛的临床效果。方法 回顾性分析自2017年3月~2019年4月期间北京市垂杨柳医院骨科收治的78例腰痛伴神经根性疼痛患者的临床病例资料，分为LTEB组（n=33）和对照组（n=45）。LTEB组采用LTEB治疗方案，而对照组采用牵引、按摩、针灸、理疗等综合保守治疗方法。记录两组患者的性别构成、年龄、症状、体格检查、病程、住院时间、随访时间。出院后2周、1个月、3个月预约门诊复查随访3~24月，治疗前、出院后2周、1个月及3个月采用数字评定法（NRS）评分及Oswestry功能障碍指数（ODI）评价治疗效果。结果 LTEB手术时间25.7±7.5 min。术后5例患者出现下肢无力感，均在24~72 h内自行恢复。所有患者治疗前后腰痛、下肢痛NRS评分及ODI评分均降低（P=0.001）。尽管术后2周LTEB组治疗后腰痛比对照组明显缓解（t=2.224，P=0.034），但是总体上两组治疗后腰痛对比和NRS评分随着时间变化没有统计学差异。LTEB治疗后下肢疼痛缓解和ODI评分明显下降（P<0.001），并随着时间变化LTEB治疗后下肢疼痛和评分明显下降（P<0.01）。结论 LTEB是一种有效治疗腰痛伴神经根性疼痛的微创方法，短期随访中，在疼痛缓解和功能改善方面效果满意。

关键词: 腰痛；脊椎穿刺；硬膜外注射；硬膜外镇痛；微创性外科手术

Abstract: Objective To evaluate the efficacy of lumbar transforaminal epidural block (LTEB) for treatment of low back pain with radicular pain. Methods We retrospectively analyzed the clinical data of 78 patients with low back pain and radicular pain admitted to the Department of Orthopedics of Beijing Chuiyangliu Hospital from March, 2017 to April, 2019. Thirty-three of the patients received treatment with LTEB (LTEB group), and 45 received comprehensive conservative treatment including traction, massage, acupuncture and physiotherapy (control group). The demographic and clinical data of the two groups were compared. The patients were followed up for 3 to 24 months, and numerical rating scale (NRS) and Oswestry disability index (ODI) scores of the patients were evaluated before the treatment and at 2 weeks, 1 month and 3 months after discharge to assess the efficacy of the treatment. Results The mean operation time of LTEB was 25.7 7.5 min (15-45 min). After the operation, 5 patients developed weakness of the lower limbs but all recovered within 24-72 h. The patients receiving LTEB all showed significantly decreased NRS scores for low back and radicular pain and ODI scores after the operation (P=0.001). At 2 weeks after the operation, the patients receiving LTEB showed significant relief of low back pain as compared with the patients in the control group (t=2.224, P=0.034), and the difference in NRS scores for low back pain between the two groups tended to diminish over time (F=1.743, P=0.183). Treatment with LTEB resulted in obvious relief of radicular pain and significant reduction of the ODI score of the patients (P<0.001), and such improvements became more obvious over time after LTEB (P<0.01). Conclusion As a minimally invasive approach, LTEB is effective for treatment of low back pain with radicular pain and can produce good short-term effects of pain relief and functional improvement.

Key words: low back pain; spinal puncture; epidural injection; epidural analgesia; minimally invasive surgery