摘要
目的探讨腰神经后内侧支阻滞对减轻椎间孔镜下经椎间孔脊柱内镜系统(transforaminal endoscopic spine system,TESSYS)技术髓核摘除术中疼痛的作用。方法单节段单侧腰椎间盘突出症患者60例,经影像、病史、体格检查诊断明确,均采用椎间孔镜手术治疗。随机分为A1组(15例)术前1%利多卡因阻滞患侧单节段腰神经后内侧支、A2组(15例)1%利多卡因阻滞患侧相邻双节段、A3组(15例)1%利多卡因阻滞患侧以手术节段为中心相邻三节段、B组(15例)患侧以手术节段为中心相邻三节段注射等量生理盐水。分析各组腰痛VAS评分(术前、术中、术后3d)、改良Macnab评分、透视次数、通道置入时间、手术时间和手术满意率。结果 4组术前VAS评分差异均无统计学意义(P>0.05);A1、A2、A3组术中VAS评分、术后VAS评分、透视次数、通道时间、手术时间低于B组,A3组低于A1、A2组,A2组低于A1组(P<0.05);4组改良Macnab手术满意率差异无统计学意义(P>0.05)。结论椎间孔镜下TESSYS治疗单节段椎间盘突出术前应用腰神经后内侧支阻滞,可降低患者术中、术后疼痛,利于患者术中配合,减少通道置入及手术时间,且多节段阻滞疼痛减轻明显。
Objective To study the function of percutaneous lumbar posteromedial branch block to lessen pain in transforaminal diskectomy using transforaminal endoscopic surgery system （TESSYS）.Methods Analysis was performed in 60 patients suffering unilateral herniation of single disc who were definitely diagnosed by radiography, medical history and physical examination. All of them undertook transforaminal endoscopic diskectomy. The patients were randomly divided into four groups ： group A1 （15 cases）, patients treated by lumbar posteromedial branch block on suffering side of single disc before surgery;group A2 （15 cases）,patients treated by lumbar posteromedial branch block on suffering side of adjacently two discs; group A3 （15 cases）, patients treated by lumbar posteromedial branch block on suffering side of adjacently three disc and the middle disc undertook surgery~ group B （15 cases）, patients injected with saline on suffering side of adjacently three disc and the middle disc undertook surgery. Then, we analyzed all the patients of three groups in VAS scores （before, during and 3 days after operation）, medical history, Modified Macnab scores, frequency of radiography, duration of working vessel inserting,operation time and satisfactory rate of surgery. Results There were no significant difference in preoperative VAS scores and Modified Macnab scores among the four groups（P〉0.05）;patients from group A1 ,group A2,group A3 had lesser value in VAS scores（during and after operation）, duration of working vessel inserting, frequency of radiography and operation time than those in group B（P〈0.05）.The values in group A3 was lesser than that in group A1 and group A2.The vales in group A2 was lesser than that in group A1 （P〈0.05）.There were no statistical difference in Modified Macnab scores among the four groups（P〉0.05）.Conclusiou Lumbar posteromedial branch blocks adopted in transforaminal diskectomy using TESSYS technique for the treatment of unilateral herniation of single disc can reduce patients pain. during and after operation, keep patient compliant, shorten the duration of working vessel inserting and operation. The multi- segmental block shows better improvement.
出处
《河北医科大学学报》
CAS
2015年第9期1014-1018,共5页
Journal of Hebei Medical University
关键词
椎间盘移位
椎间盘切除术
经皮
神经传导阻滞
疼痛
intervertebral disc displacement
diskectomy, percutaneous
nerve block
pain .
