超声引导下腓总神经阻滞对腰椎间盘突出症所致腰腿痛和下肢麻木的疗效观察-现代医学

超声引导下腓总神经阻滞对腰椎间盘突出症所致腰腿痛和下肢麻木的疗效观察

单位：1. 锦州医科大学上海市奉贤区中心医院研究生培养基地, 辽宁锦州 121001;
2. 上海市奉贤区中心医院疼痛科, 上海 201400

分类号：R441.1

出版年·卷·期（页码）：2017·36·第七期（919-924）

摘要：

目的：探讨超声引导下腓总神经阻滞对腰椎间盘突出症所致腰腿痛和下肢麻木的治疗效果。方法：选取60例经MRI或CT诊断为腰椎间盘突出症并伴有单侧下肢麻木症状的患者，采用随机数字表法随机分为超声治疗组（U组，n=30）和对照组（C组，n=30）。超声治疗组采用超声引导下骶管阻滞+超声引导下腓总神经阻滞；对照组应用超声引导下骶管阻滞+腓骨小头下方腓总神经阻滞。治疗每周一次，共治疗3次。观察和记录两组患者治疗前、治疗后30 min、1周、2周、4周的视觉模拟评分（VAS）和Von Frey纤维丝所测的触觉阈值（即麻木评分），统计各组的总有效率，以及不良反应发生情况。结果：VAS评分方面，与治疗前相比，两组治疗后各时点的分值均明显降低（P<0.05）；组间各时点VAS评分比较无明显统计学意义；麻木评分方面，与治疗前比较，两组除治疗后30 min评分无统计学意义外，两组治疗后各时间点评分值均明显降低（P<0.05），组间比较，超声治疗组在治疗两周后的评分与对照组比较有统计学意义（P<0.05）。总有效率方面，超声治疗组优于对照组（57% vs 37%）。超声治疗组不良反应发生率明显低于对照组（P<0.05）。结论：超声引导下腓总神经阻滞能有效缓解腰椎间盘突出症所致腰腿痛和下肢麻木，且操作简单，无明显不良反应，值得临床推广。

Objective: To evaluate the effect of ultrasound-guided common peroneal nerve block on the treatment of lumbocrural pain and numbness of lower limbs caused by lumbar disc herniation. Methods: 60 patients with lumbar disc herniation accompanied with numbness of lower limb diagnosed by MRI or CT were selected and randomly divided into group U(Ultrasound-guided therapy group,n=30) and group C(Control group,n=30)according to digital table. The patients in group U were treated with ultrasound-guided caudal block and ultrasound-guided common peroneal nerve block,and the patients in group C were treated with ultrasound-guided caudal block and common peroneal nerve block below the fibular head. The treatment above was repeatedonce a week for 3 weeks. Visual Analogue Scale(VAS) and tactile threshod measured with Von Frey Fibers(numbness score) were observed and recorded for each patient at pre-treatment,30 min post-treatment,1,2 and 4 weeks post-treatment. Total effective rate and side effects were recorded. Results: When compared with pre-treatment,the VAS scores of patients at each time point of post-treatment were obviously lower in both groups(P<0.05). There was no statistically significant difference between group U and group C at each time point. When compared with pre-treatment,numbness scores of patients at each time point except 30 minutes post-treatment were obviously lower in both groups(P<0.05). When compared between the groups,there was a statistical significance difference between group U and group C two weeks after treatment(P<0.05). The total effective rate of Group U was better than that of group C(57% vs 37%). Incidence of side effects of group U was lower than that in group C(P<0.05). Conclusion: With the advantage of simplicity and free of obvious side effects,Ultrasound-guided common peroneal nerve block can relieve lumbocrural pain and numbness of lower limbs caused by lumbar disc effectively and should be widely used in clinic.

参考文献：

[1] 岳寿伟,袁璐,吴宗耀,等.腰椎间盘突出症的常见症状体征调查及其临床意义[J].中华物理医学与康复杂志,2002,24(5):284-286.
[2] CRISTIAN G,WALTER M,RICARDA F,et al.Numbness in clinical and experimental pain-A cross-sectional study exploring the mechanisms of reduced tactile function[J].pain,2008,139(1):73-81.
[3] 李仲廉,郑保森,王子千.神经阻滞学-100种神经阻滞图解术[M].郑州:郑州大学出版社,2001:296-298.
[4] ELLERKMANN RK,SOEHLE M,RIESE G, et al.The Entropy module and bispectral Index as guidance for propofol-remifentanilanaesthesia in combination with regional anaesthesia compared with a standard clinical practice group[J].Anaesth Intensive Care,2010,38(1):159-166.
[5] WILDER-SMITH O H,TASSONYI E,CRUL B J,et al.Quantitative sensory testing and human surgery:effects of analgesic management on postoperative neuroplasticity[J].Anesthesiology,2003,98(5):1214-1222.
[6] 郑和平,汪华侨,张发慧.腓浅神经营养血管远端蒂皮瓣感觉重建的解剖学基础[J].中华显微外科杂志,2008,31(6):435-437.
[7] 竺永达,张俊峰.电针治疗腰椎问盘突出症术后下肢麻木172例及肌电图变化[J].浙江中医药大学学报,2012,36(5):565-567.
[8] 周肆华,杨军,孟庆刚,等.骶管注射疗效与腰椎间盘突出症不同节段、类型、病程的关系[J].中国骨伤,2013,26(7):580-583.
[9] 何晨辉,解淑灿,王建光.等.超声引导下骶管阻滞治疗腰椎间盘突出症所致腰腿痛的效果[J].广东医学,2015,36(8):1240-1243.
[10] SHAMJI M F,JING I,CHEN J,et al.Treatment of neuroinflammation by soluble tumor necrosis factor receptor typeⅡfused to a themally responsive carrier[J].J Neurosurg Spine,2008,9(2):221-228.
[11] VAN WIJK R M,GEURTS J W,WYNNE H J.Long-lasting analgesic effect of radiofrequency treatment of the lumbosacral dorsal root ganglion[J].J Neurosurg,2001,94(2 Suppl):227-231.
[12] 倪家骧.疼痛治疗中的神经阻滞技术[A].见:第五届全国门诊实用疼痛注射及神经阻滞技术新进展研讨会.第五届全国门诊实用疼痛注射及神经阻滞技术新进展研讨会论文集[C].北京:中华医学会,2011:10-17.
[13] HANSSON P,BACKONJA M,BOUHASSlRA D.Usefulness and limitations of quantitative sensory testing:clinical and research application in neuropathic pain states[J].Pain,2007,129(3):256-259.

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