摘要
为克服经后正中穿刺硬膜外腔注药和经骶管硬膜外腔注药操作复杂、易出现严重并发症的缺点，作者研究了腰椎旁垂直穿刺经椎间孔硬膜外注药治疗腰椎间盘突出症。经Ｘ光造影证实，造影剂不仅聚集在腰椎旁组织，还可通过椎间孔进入硬膜外腔。并与经后正中穿刺硬膜外腔注药治疗腰椎间盘突出症的效果进行对比观察。３０例经过临床检查和ＣＴ证实为腰椎间盘突出症的患者，随机分成腰椎旁经椎间孔硬膜外腔注射糖皮质激素局麻药组（Ａ组ｎ＝１０），腰椎旁经椎间孔硬膜外腔注射脉络宁局麻药组（Ｂ组ｎ＝１０），经后正中硬膜外腔注射糖皮质激素局麻药（Ｃ组ｎ＝１０）。每周注药一次，共治疗六周，观察腰痛、腿痛、直腿抬高、患肢感觉障碍、患肢肌力、活动限制、睡眠评分改变。组内及组间评分值用秩和检验进行统计学处理，Ｐ＜０．０５，有显著差异。经过六周治疗，除患肢感觉障碍外，三组其它各项观察指标评分出现明显升高（Ｐ＜０．０５）。Ａ组较Ｃ组在腰痛、腿痛减轻更为明显（Ｐ＜０．０５）。Ａ组与Ｂ组治疗结果无明显差异。三组均能有效地治疗腰椎间盘突出症，Ａ组较Ｃ组治疗效果更明显。脉络宁替代糖皮质激素能有效地治疗腰椎间盘突出症。腰椎旁垂直穿刺经椎间孔硬膜外腔注药治疗腰椎间盘突出症是一种更?
Abstract A new paravertebral puncture was developed for the transforaminal epidural injection and used in the treatment of lumbar disc herniation in order to avoid the aversive side effects of traditional translaminar epidural puncture. It was confirmed by fluroscopy that injected urografin could be seen passing through the formen into epidural space from paravertebral space. The therapeutic effects of the two epiduarl injection method were compared in 30 patients suffering from lumbar disc herniation. All the patients were diagnosted by clinical examination and CT scans.Thirty cases were divided randomly into three groups. Transforaminal epdiural steroid, tranforaminal epidural Mailuoning and translaminal epidural steroid were injected in group A, B and C repectively once a week for 6 weeks. The VAS of back pain and leg pain, straight-leg test, sensory deficit, muscle strength, the restriction of physical activity and sleep conditionwere observed. The therapeutic treatment in group A is better than that in group C. Themailuoning showed similar theraputic effect on the treatment of lumbar disc herniation compared with steroid. In conclusion, transforaminal epidural injection showed better theraputic effect in patients with lumbar disc herniation than translaminal epidural injection. This new method of epidural puncture is also safe and simple in use. Key word paravertrbral injection; foramen; lumbar vertebral disc herniation.
出处
《中国疼痛医学杂志》
CAS
CSCD
1998年第3期148-153,共6页
Chinese Journal of Pain Medicine
