经椎间孔选择性神经根阻滞联合微创小切口手术诊治非典型腰椎间盘突出症Transforaminal selective nerve root injection through minimal incision in treatment of atypical lambar disc herniation:a value analysis for its clinical application
何丁文;程子韵;魏强强;陈伟才;高贵程;贾惊宇;吴添龙;殷明;程细高;
摘要(Abstract):
[目的]探讨经椎间孔选择性神经根阻滞和微创小切口手术诊治非典型腰椎间盘突出症的有效性和应用价值。[方法]筛选出非典型腰椎间盘突出症18例,所有患者均经椎间孔行选择性神经根阻滞明确诊断后再行微创小切口椎间植骨融合术,采用疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)及改良下腰痛日本骨科学会(JOA)评分评估治疗效果,并观察手术时间、出血量、住院时间及并发症等情况。[结果]所有患者神经根阻滞后症状立即缓解,诊断明确后行微创小切口手术,确认4例为神经根管卡压,10例为游离髓核碎片挤压神经根腋部或肩部,4例为纤维环菲薄膨出于侧隐窝。术后VAS评分、ODI评分及JOA评分均较术前显著改善(P<0.05)。[结论]经椎间孔选择性神经根阻滞是诊断非典型腰椎间盘突出症行之有效的方法;微创小切口手术恢复快、创伤小,二者联合对非典型腰椎间盘突出症的诊治具有重要临床应用价值,值得推广。
关键词(KeyWords): 经椎间孔选择性神经根阻滞;微创;小切口手术;非典型腰椎间盘突出症
基金项目(Foundation): 江西省卫生厅科技项目(编号:20141059)
作者(Author): 何丁文;程子韵;魏强强;陈伟才;高贵程;贾惊宇;吴添龙;殷明;程细高;
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参考文献(References):
- [1]Chopko B,Liu JC,Khan MK.Anatomic surgical management of chronic low back pain[J].Neuromodulation,2014,17(2):46-51.
- [2]Gialanella B,Prometti P,Ferlucci C.Low back pain radiating to the leg:an atypical cause[J].Clin Ter,2013,164(5):417-420.
- [3]丁茹虎,刘波,张波,等.微创和开放椎间融合治疗单节段腰椎间盘突出症[J].中国组织工程研究,2013,(30):5452-5459.
- [4]Prasarn ML,Kostantinos V,Coyne E,et al.Does lumbar paraspinal muscle fatty degeneration correlate with aerobic index and Oswestry disability index[J].Surg Neurol Int,2015,6(4):240-243.
- [5]Parker SL,Godil SS,Mendenhall SK,et al.Two-year comprehensive medical management of degenerative lumbar spine disease(lumbar spondylolisthesis,stenosis,or disc herniation):a value analysis of cost,pain,disability,and quality of life:clinical article[J].J Neurosurg Spine,2014,21(2):143-149.
- [6]周强,侯伟光,丁小川,等.后路椎间盘镜手术治疗不典型腰椎间盘突出症[J].四川医学,2006,27(11):1110-1111.
- [7]任立中,郭昭庆.椎间盘造影及神经根封闭在椎间盘源性疾病中的定位诊断[J].中国矫形外科杂志,2006,14(15):1152-1154.
- [8]吴添龙,贾惊宇,高贵程,等.神经根封闭联合Quadrant微创系统诊治不典型腰椎间盘突出症[J].中国矫形外科杂志,2014,21(22):1963-1966.
- [9]Yang JC,Kim SG,Kim TW,et al.Analysis of factors contributing to postoperative spinal instability after lumbar decompression for spinal stenosis[J].Korean J Spine,2013,10(3):149-154.
- [10]李书纲,张恒岩,仉建国,等.改良直视下小切口微创手术与椎间盘镜及传统手术治疗腰椎间盘突出症的疗效比较[J].中国骨与关节外科,2012,5(2):112-116.
- [11]Manchikanti L,Abdi S,Atluri S,et al.An update of comprehensive evidence-based guidelines for interventional techniques in chronic spinal pain.Part II:guidance and recommendations[J].Pain Physician,2013,16(2 Suppl):S49-283.
- [12]Kulkarni AG,Bassi A,Dhruv A.Microendoscopic lumbar discectomy:technique and results of 188 cases[J].Indian J Orthop,2014,48(1):81-87.
- [13]Sclafani JA,Kim CW.Complications associated with the initial learning curve of minimally invasive spine surgery:a systematic review[J].Clin Orthop,2014,472(6):1711-1717.
- [14]Snyder LA,O'Toole J,Eichholz KM,et al.The technological development of minimally invasive spine surgery[J].Biomed Res Int,2014,2014:293582.