目的 :观察倍他米松结合温针在坐骨神经病变患者中的应用效果。方法 :将58例根性坐骨神经痛患者按随机数字表法分为两组,各29例。对照组给予经椎间孔注射2%利多卡因5 m L+复方倍他米松注射液2 m L+维生素B12 0.5 mg+0.9%氯化钠注射液10 ...目的 :观察倍他米松结合温针在坐骨神经病变患者中的应用效果。方法 :将58例根性坐骨神经痛患者按随机数字表法分为两组,各29例。对照组给予经椎间孔注射2%利多卡因5 m L+复方倍他米松注射液2 m L+维生素B12 0.5 mg+0.9%氯化钠注射液10 m L,qwd;研究组在对照组基础上给予温针灸,6次/周;两组均治疗4周。观察治疗前后两组血流变指标、炎症因子水平,观察治疗前、治疗后3月、6月、12月两组疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)。结果 :两组治疗后全血高切黏度、全血中切黏度、全血低切黏度、血浆黏度与治疗前比较均显著降低(P<0.05),且研究组均显著低于同期对照组(P<0.05);两组治疗后红细胞变形指数与治疗前比较均显著升高(P<0.05),且研究组高于同期对照组(P<0.05)。两组治疗后白细胞介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)-α水平与治疗前比较均显著降低(P<0.05),且研究组低于同期对照组(P<0.05)。两组治疗后3月、6月、12月VAS评分和ODI与治疗前比较均显著降低(P<0.05),且研究组低于同期对照组(P<0.05)。结论 :经椎间孔注射倍他米松联合温针灸具有协同作用,可改善血液循环,降低炎症反应程度,降低治疗后疼痛程度,且疗法易掌握,值得临床推广应用。展开更多
Background:The prevalence of low back pain with radiculopathy in general population varies from 9.9%to 25%,which can be due to bony narrowing of the lateral recess or due to prolapsed intervertebral disc.Transforamina...Background:The prevalence of low back pain with radiculopathy in general population varies from 9.9%to 25%,which can be due to bony narrowing of the lateral recess or due to prolapsed intervertebral disc.Transforaminal epidural injection of a mixture of long-acting anaesthetic(bupivacaine)and particulate steroids(depomedrol)has been a treatment modality in patients not responding to initial physiotherapy and neuropathic pain medications.Methods:To analyze the effectiveness of transforaminal epidural steroid injection(TFESI)in the treatment of low back pain with radiculopathy,a retrospective case series evaluating the records of patients that received TFESI(1 mL 0.5%bupivacaine+1 ml/40 mg depomedrol)under C-arm guidance from January 2015 to December 2018(3 years)at Upendra Devkota Memorial-National Institute of Neurological and Allied Sciences(UDM-NINAS),their lumbosacral MRI and the pre-procedure,1-week and 3-month numeric pain rating scale,were analyzed.Successful treatment(reduction of pain scale by more than 50%of baseline at 3 months)in the patients with bony recess stenosis and those with prolapsed intervertebral disc was compared.Results:Out of 67 patients that received TFESI,35(52.23%)could be followed up.The mean age was 55.8±14.39 years and 51.3%were females.68.57%had L5 and 20%had S1 radiculopathy.Bony recess stenosis was seen in the aged 40%and PIVD was the cause of radiculopathy in 60%.The median duration of radicular pain prior to intervention was 3 months.TFESI was effective as the mean numeric pain scale before injection was 8.97±1.32 which reduced to 3.91±3.23(paired t test p value<0.001)at 1 week post injection and 3.23±3.34(paired t test p value<0.001)at 3 months post injection.Twenty-six of the 35 patients(75.29%)had more than 50%pain relief compared to baseline at 3 months and were satisfied.Nine patients continued to have pain;however,only one required a surgical intervention.The effectiveness of TFESI was not significantly different in different ages(Fisher’s exact test p value 0.182)a展开更多
目的:探讨不同容量对胸段经椎间孔硬膜外注射(TFEI)药液扩散范围和镇痛效果的影响以及胸段TFEI用于诊断性阻滞的可行性。方法:选择2021年1月至2022年12月南京大学医学院附属鼓楼医院收治的胸段带状疱疹相关疼痛患者140例,随机分为4组,...目的:探讨不同容量对胸段经椎间孔硬膜外注射(TFEI)药液扩散范围和镇痛效果的影响以及胸段TFEI用于诊断性阻滞的可行性。方法:选择2021年1月至2022年12月南京大学医学院附属鼓楼医院收治的胸段带状疱疹相关疼痛患者140例,随机分为4组,实施单次TFEI并分别注入不同容量含造影剂局麻药(A组:0.2 m L;B组:0.5 m L;C组:1.0 m L;D组:2 m L),CT扫描并观察造影剂在硬膜外向头侧、尾侧及总扩散节段,造影剂在椎间孔、同侧椎旁间隙、同侧及对侧硬膜外间隙扩散情况,判断是否为选择性神经根阻滞。评估注射前、注射后30分钟及24小时视觉模拟评分(VAS)。结果:头侧和尾侧扩散节段以及总扩散节段数,D组最多,A组最少(P<0.05);C组、D组造影剂扩散≥3个节段发生率明显高于B组(P<0.05);C组、D组病例造影剂扩散至同侧椎旁间隙和对侧硬膜外间隙的发生率明显高于A组、B组(P<0.05),仅A组37.1%的病例实现选择性神经根阻滞,其余各组均无选择性阻滞病例。注射后30分钟,C、D组VAS评分显著低于A、B组(P<0.05);注射后24小时,D组VAS评分显著低于A、B组(P<0.05)。结论:胸段带状疱疹相关疼痛患者TFEI药液扩散范围随注射容量的增加而扩大,且在硬膜外倾向于头侧扩散,2 m L容量单次TFEI可阻滞3个以上的神经节段,获得良好的镇痛效果。胸段TFEI行诊断性阻滞的可行性较差。展开更多
文摘目的 :观察倍他米松结合温针在坐骨神经病变患者中的应用效果。方法 :将58例根性坐骨神经痛患者按随机数字表法分为两组,各29例。对照组给予经椎间孔注射2%利多卡因5 m L+复方倍他米松注射液2 m L+维生素B12 0.5 mg+0.9%氯化钠注射液10 m L,qwd;研究组在对照组基础上给予温针灸,6次/周;两组均治疗4周。观察治疗前后两组血流变指标、炎症因子水平,观察治疗前、治疗后3月、6月、12月两组疼痛视觉模拟评分(VAS)和Oswestry功能障碍指数(ODI)。结果 :两组治疗后全血高切黏度、全血中切黏度、全血低切黏度、血浆黏度与治疗前比较均显著降低(P<0.05),且研究组均显著低于同期对照组(P<0.05);两组治疗后红细胞变形指数与治疗前比较均显著升高(P<0.05),且研究组高于同期对照组(P<0.05)。两组治疗后白细胞介素(IL)-1β、IL-6、肿瘤坏死因子(TNF)-α水平与治疗前比较均显著降低(P<0.05),且研究组低于同期对照组(P<0.05)。两组治疗后3月、6月、12月VAS评分和ODI与治疗前比较均显著降低(P<0.05),且研究组低于同期对照组(P<0.05)。结论 :经椎间孔注射倍他米松联合温针灸具有协同作用,可改善血液循环,降低炎症反应程度,降低治疗后疼痛程度,且疗法易掌握,值得临床推广应用。
文摘Background:The prevalence of low back pain with radiculopathy in general population varies from 9.9%to 25%,which can be due to bony narrowing of the lateral recess or due to prolapsed intervertebral disc.Transforaminal epidural injection of a mixture of long-acting anaesthetic(bupivacaine)and particulate steroids(depomedrol)has been a treatment modality in patients not responding to initial physiotherapy and neuropathic pain medications.Methods:To analyze the effectiveness of transforaminal epidural steroid injection(TFESI)in the treatment of low back pain with radiculopathy,a retrospective case series evaluating the records of patients that received TFESI(1 mL 0.5%bupivacaine+1 ml/40 mg depomedrol)under C-arm guidance from January 2015 to December 2018(3 years)at Upendra Devkota Memorial-National Institute of Neurological and Allied Sciences(UDM-NINAS),their lumbosacral MRI and the pre-procedure,1-week and 3-month numeric pain rating scale,were analyzed.Successful treatment(reduction of pain scale by more than 50%of baseline at 3 months)in the patients with bony recess stenosis and those with prolapsed intervertebral disc was compared.Results:Out of 67 patients that received TFESI,35(52.23%)could be followed up.The mean age was 55.8±14.39 years and 51.3%were females.68.57%had L5 and 20%had S1 radiculopathy.Bony recess stenosis was seen in the aged 40%and PIVD was the cause of radiculopathy in 60%.The median duration of radicular pain prior to intervention was 3 months.TFESI was effective as the mean numeric pain scale before injection was 8.97±1.32 which reduced to 3.91±3.23(paired t test p value<0.001)at 1 week post injection and 3.23±3.34(paired t test p value<0.001)at 3 months post injection.Twenty-six of the 35 patients(75.29%)had more than 50%pain relief compared to baseline at 3 months and were satisfied.Nine patients continued to have pain;however,only one required a surgical intervention.The effectiveness of TFESI was not significantly different in different ages(Fisher’s exact test p value 0.182)a
文摘目的:探讨不同容量对胸段经椎间孔硬膜外注射(TFEI)药液扩散范围和镇痛效果的影响以及胸段TFEI用于诊断性阻滞的可行性。方法:选择2021年1月至2022年12月南京大学医学院附属鼓楼医院收治的胸段带状疱疹相关疼痛患者140例,随机分为4组,实施单次TFEI并分别注入不同容量含造影剂局麻药(A组:0.2 m L;B组:0.5 m L;C组:1.0 m L;D组:2 m L),CT扫描并观察造影剂在硬膜外向头侧、尾侧及总扩散节段,造影剂在椎间孔、同侧椎旁间隙、同侧及对侧硬膜外间隙扩散情况,判断是否为选择性神经根阻滞。评估注射前、注射后30分钟及24小时视觉模拟评分(VAS)。结果:头侧和尾侧扩散节段以及总扩散节段数,D组最多,A组最少(P<0.05);C组、D组造影剂扩散≥3个节段发生率明显高于B组(P<0.05);C组、D组病例造影剂扩散至同侧椎旁间隙和对侧硬膜外间隙的发生率明显高于A组、B组(P<0.05),仅A组37.1%的病例实现选择性神经根阻滞,其余各组均无选择性阻滞病例。注射后30分钟,C、D组VAS评分显著低于A、B组(P<0.05);注射后24小时,D组VAS评分显著低于A、B组(P<0.05)。结论:胸段带状疱疹相关疼痛患者TFEI药液扩散范围随注射容量的增加而扩大,且在硬膜外倾向于头侧扩散,2 m L容量单次TFEI可阻滞3个以上的神经节段,获得良好的镇痛效果。胸段TFEI行诊断性阻滞的可行性较差。
