超声引导下复合阻滞治疗腰椎术后下腰部疼痛的疗效分析
Therapeutic effect of ultrasound-guided multiple block therapy for patients with low back pain after lumbar surgery
苏珊珊 1张汪彤 2丁文慧 2李城 1姚吉祥 1赵忠民1
作者信息
- 1. 南京医科大学附属泰州人民医院疼痛科,泰州市 225300
- 2. 长春中医药大学中西医结合学院,长春市 130117
- 折叠
摘要
目的 评价超声引导下复合阻滞治疗腰椎术后下腰部疼痛的疗效及安全性.方法 回顾性分析2019年3月至2023年6月就诊于南京医科大学附属泰州人民医院疼痛科的腰椎术后下腰痛患者62例,在超声引导下椎旁神经阻滞和责任脊神经后内侧支阻滞,同时行脊柱关节突关节阻滞及关节囊松解,每次注射盐酸利多卡因和复方倍他米松混合液9～11 ml.每周1次超声引导下复合阻滞治疗,最多治疗3次.比较治疗前和治疗后1、4及12周时疼痛数字评价量表评分(NRS)及腰椎Oswestry功能障碍指数(ODI)评分.采用改良MacNab方法进行综合疗效与是否合并小关节病变的疗效评定与分析.观察治疗可能发生的不良反应与并发症(如麻木、疼痛加重、血肿、感染、神经损伤、毒麻药中毒等)发生情况.结果 本组病例均顺利完成治疗.与治疗前相比,治疗后各评估时点NRS评分及ODI指数均较治疗前降低(P＜0.05),差异具有统计学意义;治疗后12周,根据MacNab评定疗效,优效16例、良效20例、可效15例、差效11例,优良率58.1％(36/62例),合并小关节病变的患者,优良率65.8％(27/41例).本组患者未见麻木、疼痛加重、血肿、感染、神经损伤、毒麻药中毒等不良反应.结论 超声引导下复合神经阻滞治疗腰椎术后下腰痛是一种安全有效的方法.
Abstract
Objective To evaluate the efficacy and safety of ultrasound-guided multiple block in the treatment of patients with low back pain after lumbar surgery.Methods A retrospective analysis were performed in 62 patients with lumbar low back pain in the Department of Painology,Taizhou People's Hospital affiliated to Nanjing Medical University,from March 2019 to June 2023.Under the ultrasound guidance nerve block,spinal joint block and joint capsule release were performed,and lidocaine hydrochloride and compound betamethasone mixture 9-11 ml were injected in each block,once a week for a maximum 3 times.Numerical rating scale(NRS)and lumbar Oswestry dysfunction index(ODI)were compared before and 1,4 and 12 weeks after the treatment.The modified MacNab method was used to evaluate the efficacy.Adverse reactions and complications,such as numbness,pain aggravation,hematoma,infection,nerve injury,toxic and anesthetic poisoning were observed.Results Compared with pre-treatment,NRS and ODI were lower 12 weeks after the treatment(P＜0.05).The excellent and good rate were 58.1％,among them 16 patients with excellent,20 patients with good,15 patients with acceptable and 11 patients with poor effect.In patients with facet joint disease,the excellent rate was 65.8％(27/41 cases).No adverse effects happened in all patients.Conclusion Ultrasound-guided compound nerve block is a safe and effective method for the treatment of low back pain after lumbar surgery.
关键词
腰痛/疼痛,手术后/超声引导/复合阻滞Key words
Low back pain/Pain,postoperative/Ultrasound guidance/Compound block引用本文复制引用
出版年
2024
NETL
NSTL
万方数据