摘要
[目的]硬膜外注射麻药和(或)类固醇等多种介入技术通常用以治疗有关的椎管狭窄症的疼痛。肿瘤坏死因子-α在腰椎间盘突出及椎管狭窄神经根疼痛中发挥了至关重要的作用。肿瘤坏死因子-α抑制剂已被用来控制癌症、类风湿性关节炎和一些其他系统性的自身免疫性疾病所造成的疼痛。这项研究是评估硬膜外注射与单纯局部麻醉、局部麻醉药与肿瘤坏死因子-α抑制剂混合和局部麻醉药与类固醇激素混合在缓解慢性腰痛与腰椎管狭窄症有关腰痛的治疗中的作用。[方法]对90例下腰痛和下肢根性疼痛患者进行了调查。分别进行体格检查、X线及MRI做出诊断。随机分成3组。第1组患者在受累神经根处硬膜外注射2.0 ml的利多卡因和10 mg的肿瘤坏死因子-α抑制剂(依那西普),第2组患者注射利多卡因2 ml与2 ml类固醇激素(得宝松),第3组患者只注射利多卡因4.0ml。下腰痛和下肢疼痛评估使用视觉模拟疼痛评分(VAS)评估术前和术后1周疼痛程度。[结果]3组病例患者下腰痛和腿部疼痛的程度在局部硬膜外注射前没有明显不同。第1组患者的疼痛改善程度比第2组和第3组明显高;但第2组和第3组并没有明显差别。[结论]研究结果表明硬膜外注射肿瘤坏死因子-α抑制剂可能是一种治疗椎管狭窄引起的神经根疼痛的有效方法。单纯硬膜外注射麻药和局麻药混合类固醇激素疼痛缓解无明显区别。
[Objective] Multiple interventional techniques such as epidural injections of local anesthetic and /or Steroids commonly performed in managing pain related to spinal stenosis.TNF-α is thought to play a crucial role in the radicular pain caused by lumbar disc herniation and spinal stenosis.Tumor necrosis factor-alpha inhibitor has been used to control pain caused by cancer,Rheumatoid arthritis and some other systemic autoimmune disorder.This study is to assess the efiects of caudal epidural injections with local anesthetic only,local anesthetic mixed with tumor necrosis factor-alpha inhibitor,and local anesthetic mixed with steroids in pain relief in the management of chronic low back pain related to lumbar spinal stenosis.[Methods] Ninty patients with low back and radicular leg pain were investigated.We diagnosed the patients by physical examination,and X-ray and magnetic resonance imaging.They were randomly assigned to1 of the 3 groups.Group I patients received caudal epidural injections administered 2.0 ml of lidocaine and 10 mg of tumor necrosis factor-alpha inhibitor（etanercept） onto the affected spinal nerve,and Group II patients received caudal epidural injections with lidocaine 2 ml mixed with 2mL of steroid（Diprospan）,group III patients received caudal epidural injections with 4.0 ml of lidocaine only.Low back and leg pain were evaluated using a visual analogue scale（VAS） before and for 1 week after epidural administration.[Results] Low back and leg pain in the 3 groups were not significantly different before epidural administration.And significant pain relief improvement in group I was more effective than that of group II and group III;while it showed no significant difference between group II and group III.[Conclusion] Our results indicate that epidural administration of a TNF-α inhibitor may be useful tools for the treatment of radicular pain caused by spinal stenosis.Caudal epidural injections of local anesthetic with or without steroids seems no difference.
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2013年第17期1767-1770,共4页
Orthopedic Journal of China
