摘要
目的:探讨C形臂透视引导针刀切断脊神经后内侧支去神经化治疗腰椎关节突关节源性腰痛的有效性与安全性。方法:自2009年3月至2010年10月,分别采用针刀切断脊神经后内侧支治疗腰椎关节突关节源性腰痛患者30例。单支切断15例、双支切断9例、三支切断6例。评价采用术后1周、3个月、6个月患者腰背部疼痛的VAS评分,术后6个月测定致痛关节突关节水平多裂肌表面肌电信号,并于术后6个月进行腰椎MRI检查,测量多裂肌横断面积、萎缩率。结果:患者术后1周、3个月、6个月腰背疼痛VAS评分均低于治疗前(P<0.05),术后6个月多裂肌肌电信号测试值均低于切断治疗前基础值,但三支切断组肌电信号值明显变小(P<0.05)。单支、双支切断组6个月后MRI检查测量多裂肌横断面积无明显变化,三支切断组多裂肌横断面积减小(P<0.05),有退变萎缩表现。结论:脊神经后内侧支切断去神经化治疗腰椎关节突关节源性腰痛是有效的,单支、双支切断脊神经后内侧支治疗是相对安全的,未出现明显退变萎缩情况。三支切断治疗有一定风险,应谨慎使用。
Objective： To explore efficacy and safety of using denervation of dorsal medial branch to treat the back pain due to origin from lumbar joint.Methods： From March 2009 to October 2010,30 patients diagnosed the back pain due to origin from lumbar joint.They were blocked single branch,dual branches,three branches of dorsal medial branch in disease lumbar facet joint,up and down several neighboring lumbar facet joints by C-arm fluoroscopic guidance.To evaluate the VAS and back muscle strength of patients were blocked before and after by single branch,dual branches,three branches of dorsal medial branch in disease lumbar facet joint,up and down several neighboring lumbar facet joints.Back muscle strength measured using the back power meter.Results： 30 patients back pain after blocked dorsal medial branch using VAS score were significantly lower than before blocked,dual branch blocked the VAS score and back muscle strength were lower than single branch blocked,three branch blocked the VAS score and back muscle strength were lower than dual branch blocked.Conclusion： Using denervation of dorsal medial branch to treat the back pain due to origin from lumbar joint was effective,dual branch blocked was more effective than single branch blocked,three branches blocked was more effective than dual branches blocked.The back muscle strength was no significant decline in single branch blocked and dual branch blocked,no significant changes in surface EMG,but the back muscle strength was significant decline in three branch blocked,surface EMG was significant changes.Therefore,single and dual of dorsal medial branch blocked was safety.There was a certain risk in three of dorsal medial branch blocked,we should be used with caution.
出处
《中华中医药杂志》
CAS
CSCD
北大核心
2013年第4期1136-1139,共4页
China Journal of Traditional Chinese Medicine and Pharmacy
基金
浙江省中医药科技计划(No.2009CA027)~~
