目的观察臭氧在侧隐窝联合椎旁肌肉内注射治疗伴有腰椎间盘突出的急性下背痛的临床效果。方法选取2014年6月至2015年6月期间伴有腰椎间盘突出的急性下背痛患者132例,随机分为实验组(A组)和对照组(B组)。入组患者均签署了知情同意书。首...目的观察臭氧在侧隐窝联合椎旁肌肉内注射治疗伴有腰椎间盘突出的急性下背痛的临床效果。方法选取2014年6月至2015年6月期间伴有腰椎间盘突出的急性下背痛患者132例,随机分为实验组(A组)和对照组(B组)。入组患者均签署了知情同意书。首次治疗2组均在CT引导下进行病变部位的侧隐窝穿刺,A组注入3 m L臭氧(25μg/m L),B组注入3 m L甲泼尼龙琥珀酸钠(40 mg);同时在病变间盘相邻的两节腰椎旁肌肉内注射,A组每点注入5 m L臭氧(25μg/m L),B组每点注入5 m L利多卡因溶液(0.5%)。侧隐窝注射只做1次,椎旁肌肉内的注射需重复进行,每周3次,连续治疗3周。采用视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评价患者疼痛及腰椎功能情况,记录患者治疗前,治疗后15 d、30 d、3个月的VAS评分及ODI值。结果 132例患者均获得完整随访,A组治疗后各时间点VAS评分及ODI分值均低于术前及同时间段的对照组,差异均有统计学意义(P<0.05);A组在第30天随访时出现最好疗效并维持至随访结束。结论臭氧在侧隐窝联合椎旁肌肉内注射可以有效缓解伴有腰椎间盘突出的急性下背痛,值得临床推广应用。展开更多
An outward-going intervertebral foramina puncture along the side of lumbar vertebra spinous process was used to avoid infusing drugs into the subarachnoid space. However, we still had an inadvertent malpractice. The p...An outward-going intervertebral foramina puncture along the side of lumbar vertebra spinous process was used to avoid infusing drugs into the subarachnoid space. However, we still had an inadvertent malpractice. The patient was diagnosed with lumbar discogenic lower back pain and was administrated an outward-going intervertebral foramina puncture through the side of lumbar vertebra spinous process (L5</sub>-S1</sub>). The drug mixture, containing triamcinolone acetonide suspension, cyanocobalamin and bupivacaine HCl, was injected. The patient had palpitations, chest tightness, dyspnea, bradycardia, and hypotension 3 min right after the injection. The vital signs gradually stabilized after treatment with atropine sulfate;however, he had complete sensorimotor loss below the level of distribution of the T2</sub> spinal nerve. The cerebrospinal fluid pressure was lower in the subarachnoid space and the cerebrospinal fluid was slightly turbid and light pink in color. Six hours later, the sensory, motor, defecation, and urination functions returned to normal level. The patient had follow-up evaluations at 1, 3, and 6 months. The lumbar and hip pain was mild-to-severe at times as usual, but there were no other neurologic sequelae. Conclusions: This case showed that there is a risk that drugs may stray into the subarachnoid space during an outward-going intervertebral foramina puncture through the side of lumbar vertebral spinous process. The complication may occur due to a distal nerve root cyst. The result of triamcinolone acetonide suspension and cyanocobalamin injection into the cerebrospinal fluid was not as serious as we imagined.展开更多
文摘目的观察臭氧在侧隐窝联合椎旁肌肉内注射治疗伴有腰椎间盘突出的急性下背痛的临床效果。方法选取2014年6月至2015年6月期间伴有腰椎间盘突出的急性下背痛患者132例,随机分为实验组(A组)和对照组(B组)。入组患者均签署了知情同意书。首次治疗2组均在CT引导下进行病变部位的侧隐窝穿刺,A组注入3 m L臭氧(25μg/m L),B组注入3 m L甲泼尼龙琥珀酸钠(40 mg);同时在病变间盘相邻的两节腰椎旁肌肉内注射,A组每点注入5 m L臭氧(25μg/m L),B组每点注入5 m L利多卡因溶液(0.5%)。侧隐窝注射只做1次,椎旁肌肉内的注射需重复进行,每周3次,连续治疗3周。采用视觉模拟评分(VAS)及Oswestry功能障碍指数(ODI)评价患者疼痛及腰椎功能情况,记录患者治疗前,治疗后15 d、30 d、3个月的VAS评分及ODI值。结果 132例患者均获得完整随访,A组治疗后各时间点VAS评分及ODI分值均低于术前及同时间段的对照组,差异均有统计学意义(P<0.05);A组在第30天随访时出现最好疗效并维持至随访结束。结论臭氧在侧隐窝联合椎旁肌肉内注射可以有效缓解伴有腰椎间盘突出的急性下背痛,值得临床推广应用。
文摘An outward-going intervertebral foramina puncture along the side of lumbar vertebra spinous process was used to avoid infusing drugs into the subarachnoid space. However, we still had an inadvertent malpractice. The patient was diagnosed with lumbar discogenic lower back pain and was administrated an outward-going intervertebral foramina puncture through the side of lumbar vertebra spinous process (L5</sub>-S1</sub>). The drug mixture, containing triamcinolone acetonide suspension, cyanocobalamin and bupivacaine HCl, was injected. The patient had palpitations, chest tightness, dyspnea, bradycardia, and hypotension 3 min right after the injection. The vital signs gradually stabilized after treatment with atropine sulfate;however, he had complete sensorimotor loss below the level of distribution of the T2</sub> spinal nerve. The cerebrospinal fluid pressure was lower in the subarachnoid space and the cerebrospinal fluid was slightly turbid and light pink in color. Six hours later, the sensory, motor, defecation, and urination functions returned to normal level. The patient had follow-up evaluations at 1, 3, and 6 months. The lumbar and hip pain was mild-to-severe at times as usual, but there were no other neurologic sequelae. Conclusions: This case showed that there is a risk that drugs may stray into the subarachnoid space during an outward-going intervertebral foramina puncture through the side of lumbar vertebral spinous process. The complication may occur due to a distal nerve root cyst. The result of triamcinolone acetonide suspension and cyanocobalamin injection into the cerebrospinal fluid was not as serious as we imagined.
