选择性神经根阻滞术在精准治疗多节段腰椎退行性病变的意义
| 作 者：赵光宗, 彭振宇, 李世芳, 李小勇, 陈晟民 |
| 单 位：郴州市第四人民医院 |
| 基金项目：郴州市科学技术局科技发展计划项目 |
| 摘 要： |
| 目的 探讨选择性神经根阻滞术(SNRB)在精准治疗多节段腰椎退行性病变中的意义。方法 回顾性研究2020年1月～2021年12月在我科行手术的36例多节段腰椎退行性病变患者。根据术前是否行选择性神经根阻滞术明确责任节段分为选择性神经根阻滞组与非选择性神经根阻滞组，每组18例患者。选择性神经根阻滞组患者术前行SNRB明确责任节段后行相应节段的减压融合内固定；非选择性神经根阻滞组患者因为术前责任节段不明确，根据MRI图像采用预防性减压融合内固定。分别记录并分析两组患者术前、术后第7天、术后6个月、末次随访的VAS评分、JOA评分、住院时间、住院费用，为治疗提供选择策略。结果 选择性神经根阻滞组患者阻滞过程无神经损伤，所有病人均获得随访，随访时间10～21个月，平均14.1个月。两组患者术后第7天、术后6个月、末次随访的VAS评分、JOA评分较术前均明显改善，差异均有统计学意义（P均0.05）。选择性神经根阻滞组住院时间、住院费用优于非选择性神经根阻滞组，差异均有统计学意义（P均0.05）。结论 选择性神经根阻滞术定位精准、有效，对于定位不确定的多节段腰椎退行性病变的患者，术前通过选择性神经根阻滞术定位责任节段、精准减压，在达到可靠疗效的同时可减少预防性减压带来的手术创伤，减少住院时间及住院费用。 |
| 关键词：选择性神经根阻滞术；腰椎退行性病变；多节段；责任节段 |
Significance of selective nerve root block in the precise treatment of multisegmental lumbar degenerative lesions
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| Abstract: |
| OBJECTIVE To investigate the significance of selective nerve root block (SNRB) in the precise treatment of multisegmental lumbar degenerative lesions. METHODS Thirty-six patients with multisegmental lumbar degenerative lesions who underwent surgery in our department from January 2020 to December 2021 were retrospectively studied. The patients were divided into selective nerve root block group and non-selective nerve root block group according to whether selective nerve root block was performed preoperatively to clarify the responsible segment, with 18 patients in each group. The patients in the selective nerve root block group had preoperative SNRB to clarify the responsible segment and then underwent decompression fusion for internal fixation of the corresponding segment; in the non-selective nerve root block group, because the responsible segment was not clarified preoperatively, prophylactic decompression fusion was used for internal fixation based on MRI images. The VAS scores, JOA scores, length of stay, and hospital costs were recorded and analyzed in the two groups before surgery, on postoperative 7th day and 6th month after surgery, and at the last follow-up, respectively, to provide a treatment selection strategy. RESULTS Patients in the selective nerve root block group had no nerve injury during the block, all patients were obtained with a follow-up period of 10 to 21 months, with a mean of 14.1 months. The VAS scores and JOA scores of patients in both groups on postoperative day 7, 6 months after surgery, and at the last follow-up were significantly improved compared with those before surgery, and the differences were statistically significant (P0.05). The VAS score and JOA score on the length of hospitalization and hospital cost were better in the selective nerve root block group than in the non-selective nerve root block group, and the differences were statistically significant (P0.05). CONCLUSION Selective nerve root block is precise and effective in positioning, and for patients with multisegmental lumbar degenerative lesions whose positioning is uncertain, preoperative positioning of the responsible segment by selective nerve root block and precise decompression can reduce the surgical trauma caused by prophylactic decompression and reduce hospitalization time and hospitalization cost while achieving reliable efficacy. |
| Keywords: Selective nerve root block;Lumbar degenerative lesions; Multi segment; Responsibility segment |
| 投稿时间：2023-03-09 |
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