摘要
目的评估超声引导下选择性神经根封闭术在手术治疗多节段腰椎退变中的指导价值。方法采用回顾性病例对照研究的方法分析2019年1月—2021年12月于西安交通大学附属红会医院收治的47例接受减压手术治疗的多节段腰椎退变患者的临床资料。根据术前是否行超声引导下选择性神经根封闭术分为神经根封闭组(n=22)及非神经根封闭组(n=25)。记录并比较两组患者的手术时间、术中出血量、减压椎板数、术后引流量及住院天数,比较两组患者术前及随访期间腰痛视觉模拟评分(VAS)、腿痛VAS、日本骨科协会(JOA)评分及Oswestry功能障碍(ODI)评分等。正态分布的计量资料以均数±标准差(x±s)表示,组间比较采用配对t检验,计数资料组间比较采用χ^(2)检验。结果47例患者均顺利完成手术,术中未发生神经血管损伤等严重并发症,所有患者获得(27.6±7.5)个月随访。神经根封闭组手术时间、术中出血量、减压椎板数、术后引流量、住院天数分别为(90.5±12.6)min、(110.5±15.8)mL、(1.2±0.8)个、(85.6±15.8)mL、(6.2±2.8)d,非神经根封闭组分别为(190.6±25.5)min、(450.5±24.8)mL、(3.8±1.6)个、(210.5±16.8)mL、(9.5±2.2)d,神经根封闭组均显著少于非神经根封闭组,两组相比差异具有统计学意义(P<0.05)。两组患者术后及随访期间腰腿疼痛VAS、JOA评分和ODI评分较术前均有显著改善(P<0.05)。神经封闭组患者术后第3天、术后6个月及末次随访时的腰痛VAS分别为(3.2±1.4)分、(1.4±0.8)分、(0.5±0.2)分,JOA评分分别为(15.8±4.3)分、(21.3±5.6)分、(25.6±1.4)分,ODI评分分别为(50.6±10.3)分、(22.8±7.8)分、(16.8±4.2)分,非神经根封闭组患者术后第3天、术后6个月及末次随访时的腰痛VAS分别为(5.1±1.8)分、(3.4±1.2)分、(1.8±0.5)分,JOA评分分别为(14.1±4.8)分、(20.5±3.2)分、(24.2±1.8)分,ODI评分分别为(60.5±9.8)分、(31.6±8.2)分、(21.3±5.5)分,神经根封闭组均优于非神经封闭组,两组相比差异有统计学意义(P<0.05),两组患者术后及随访期间腿痛VAS相比差异无统计学意义(P>0.05)。末次随访时两组患者内固定位置良好,无松动移位,植骨均融合良好。结论对于多节段腰椎退变患者,术前行超声引导下选择性神经根封闭术可以明确责任节段,依此进行的选择性减压融合术,可有效减少手术创伤,同时改善患者腰腿痛及身体功能,具有重要的手术指导价值。
Objective To evaluate the guiding value of ultrasound-guided selective nerve root block in the surgical treatment of multilevel lumbar degeneration.Methods Retrospective case-control study was used.Clinical data of 47 patients with multi-level lumbar degeneration who underwent decompression surgery in Honghui Hospital,Xi′an Jiaotong University from January 2019 to December 2021 were retrospectively analyzed.They were divided into nerve root block group(n=22)and non-nerve root block group(n=25)according to whether ultrasound-guided selective nerve root block was performed before decompression surgery.The operation time,intraoperative blood loss,number of decompression laminae,postoperative drainage volume and length of stay of the two groups were recorded and compared.The visual analogue scale of low back pain,the visual analogue scale(VAS)of leg pain,the Japanese orthopaedic association(JOA)score and Oswestry disability index(ODI)score were all compared before surgery and during follow-up between the two groups.Measurement data with normal distribution were represented as mean±standard deviation(x±s),and the comparison between groups was conducted using the paired t-test.Chi-square test was used for counting data.Results All 47 patients successfully completed the operation without any serious complications such as neurovascular injury.All patients were followed up for(27.6±7.5)months.In the nerve root block group,the operation time,intraoperative blood loss,number of decompression laminae,postoperative drainage volume and hospital stay were(90.5±12.6)min,(110.5±15.8)mL,1.2±0.8,(85.6±15.8)mL,(6.2±2.8)d,respectively.In the non-root block group,they were(190.6±25.5)min,(450.5±24.8)mL,3.8±1.6,(210.5±16.8)mL,(9.5±2.2)d,respectively.The above indexes in the nerve root closure group were less than those in the non-root closure group,and the difference was significant between the two groups(P<0.05).The scores of VAS of low back pain and leg pain,JOA and ODI in both groups were significantly improved after surgery and during the follow-up period when compared with those of pre-operation(P<0.05).The VAS scores of low back pain on the 3rd day,6 months after operation and at the last follow-up in the nerve block group were 3.2±1.4,1.4±0.8,0.5±0.2,the JOA scores were 15.8±4.3,21.3±5.6,25.6±1.4,and the ODI scores were 50.6±10.3,22.8±7.8,16.8±4.2,respectively.The VAS scores of low back pain on the 3rd day,6 months after operation and at the last follow-up in the non-nerve block group were 5.1±1.8,3.4±1.2,1.8±0.5,the JOA scores were 14.1±4.8,20.5±3.2,24.2±1.8,and the ODI scores were 60.5±9.8,31.6±8.2 and 21.3±5.5,respectively.The difference between the two groups was statistically significant(P<0.05).However,there was no statistical difference in the VAS scores of leg pain between the two groups after surgery and during follow-up(P>0.05).At the last follow-up,the internal fixation position of the two groups was good,no loosening and displacement,and bone graft fusion was good.Conclusion For patients with multi-level lumbar degeneration,ultrasound-guided selective nerve root block before surgery can identify the responsible segment,and selective decompression and fusion based on this can effectively reduce surgical trauma,while improving patients′back and leg pain and physical function,which has important surgical guidance value.
作者
葛朝元
杨文龙
钱立雄
杨小卫
郝定均
许正伟
Ge Chaoyuan;Yang Wenlong;Qian Lixiong;Yang Xiaowei;Hao Dingjun;Xu Zhengwei(Department of Spine Surgery,Honghui Hospital,Xi′an Jiaotong University,Xi′an 710054,China)
出处
《国际外科学杂志》
2024年第3期174-180,F0004,共8页
International Journal of Surgery
基金
国家自然科学基金重点项目(81830077)。
关键词
超声检查
腰椎
减压术
外科
脊柱融合术
选择性神经根封闭术
多节段腰椎退变
Ultrasonography
Lumbar vertebrae
Decompression,surgical
Spinal fusion
Selective nerve root closure
Multi-segmental lumbar degeneration
