摘要
目的前瞻性研究内窥镜下腰脊神经背内侧支解剖变异特点,评估内窥镜下腰脊神经背内侧支切断术治疗腰椎关节突关节源性慢性腰痛的效果。方法 2011年4月至2011年10月,共45例慢性腰痛患者,经2次分别使用利多卡因和布比卡因行对照性脊神经背内侧支封闭术证实疼痛80%以上来源于腰椎关节突关节。采用内窥镜下脊神经背内侧支切断术治疗。对脊神经背内侧支走行进行记录、分析。记录不同时间点患者腰痛及牵涉痛的VAS评分,包括封闭前、封闭后、术后1天,3、6、12个月。评估术后12个月时腰椎MacNab功能评分。结果内窥镜下腰脊神经背内侧支存在多种解剖变异,包括走行、粗细、骨膜包裹等变异。内窥镜下腰脊神经背内侧支切断术后腰痛及牵涉痛VAS评分较封闭前均明显降低(P<0.05),而与封闭后腰痛及牵涉痛vAS评分差异无统计学意义(P>0.05)。1年随访MacNab功能评分:优27例,良17例,可1例。无手术并发症发生。结论内窥镜下探查腰脊神经背内侧支可以发现可能存在的解剖变异,内窥镜下脊神经背内侧支切断术可以提高腰椎关节突关节源性慢性腰痛治疗的有效率及疗效维持时间。
Objective To prospectively study the endoscopic anatomical variants of medial branch of dorsal ramus of lumbar spinal nerve and the clinical outcomes of dorsal endoscopic rhizotomy （ endoscopic lumbar medial branch neurotomy ） for the treatment of chronic lumbar zygapophyseal joint pain. Methods From April 2011 to October 2011, 45 patients with chronic low back pain were diagnosed as chronic lumbar zygapophyseal joint pain by more than 80% pain relief after controlled differential （ double ） medial branch block （ MBB ） with lidocaine and bupivacaine respectively. They were treated with dorsal endoscopic rhizotomy. Characteristics of the medial branch under endoscope were recorded and analyzed. The VAS scores of low back pain and referred pain were recorded and compared at each time point, including VAS scores before MBB, after MBB, 1 day postoperatively, 3 months postoperatively, 6 months postoperatively and 12 months postoperatively. MacNab scores were evaluated at 1-year follow-up. Results Many anatomical variants of medial branch were found, including the path, diameter, periosteum covering, etc. VAS scores of postoperative low back pain and referred pain were significantly decreased comparing with that before MBB （ P〈0.05 ） and which was not significantly different from that after MBB （ P〉0.05 ）. MacNab scores at 1-year follow-up included 27 excellent, 17 good and 1 fair. No complications occurred. Conclusions Anatomical variants of medial branch of dorsal rarnus of lumbar spinal nerve can be found under endoscopic exploration. Dorsal endoscopic rhizotomy can improve the clinical outcomes of chronic lumbar zygapophyseal joint pain, including the effective rate and the duration of effects.
出处
《中国骨与关节杂志》
CAS
2013年第4期188-193,共6页
Chinese Journal of Bone and Joint
基金
首都临床特色应用研究基金资助课题(编号:Z121107001012097)
关键词
椎间盘移位
腰椎
外科手术
微创性
椎间盘退行性变
椎间盘切除术
经皮
内窥镜
Intervertebral disk displacement
Lumbar vertebrae
Surgical procedure, minimally invasive
Intervetebral disc degeneration
Diskectomy, percutaneous
Endoscopes
