第48卷第4期第446页2019年8月华中科技大学学报(医学版)Acta Med Univ Sci Technol HuazhongVol. 48 No. 4 P. 446Aug. 2019DSA引导下腰脊神经后支松解治疗老年患者小关节
*源性腰痛的临床研究冯丹，李少军△,袁峰，张书力，胡恰，乔杰武汉市第一医院疼痛科，武汉 430022摘要:目的 观察在数字减影血管造影技术(digital subtraction angiography,DSA)引导下腰脊神经后支松解治疗老
年患者小关节源性腰痛的疗效及安全性。方法 分析2016年7月至2018年7月在武汉市第一医院疼痛科治疗的148
例腰椎小关节源性疼痛患者的临床资料。所纳入研究患者随机分为两组，松解组5=76)和药物组(” = 72)。松解组在 DSA引导下采用一次性硬膜外穿刺包中硬膜外穿刺针钝性分离腰脊神经后支。药物组患者采用口服消炎镇痛药物治
疗。采用视觉模拟评分法(visual analogue scores,VAS)、腰椎功能障碍问卷(Roland-Morris questionnaireRMQ)*及 Os-
westry 功能障碍指数(Oswestry disability index,ODI)评估治疗前及治疗后1、6个月时患者疼痛评分和患者腰椎功能评 分。 结果 本研究首次报道DSA引导下腰脊神经后支松解治疗老年患者小关节源性腰痛。在治疗1个月及6个月
时，松解组患者VAS得分明显低于药物组患者，差异有统计学意义［(3.4±1. 1) P5. (4?0 士 1.3)?P = 0.013；(2.9±l. 1)
述(4. 1 士 1.3),PV0.001］。同样，在治疗1个月及6个月时，松解组患者的RMQ得分、()DI得分明显低于药物组，差
异有统计学意义(均PV0.05)。松解组76例患者无麻木及感染等并发症。结论 DSA引导下腰脊神经后支松解治疗
可有效缓解老年患者腰椎小关节源性的腰痛症状和改善患者腰部功能状况，且操作安全，无不良反应，值得推广。关键词：腰椎小关节；脊神经后支；神经松解治疗；腰椎功能中图分类号:R323. 4
DOl：10. 3870/j. issn. 1672-0741. 2019. 04. 014Clinical Observation of DSA-guided Neurolysis of Posterior Ramus of Lumbar Spinal
Nerve on Old Patients with Facet-joint-related Lumbar PainFeng Dan,Li ShaojunA , Yuan Feng et alDepartment of Pain Management iWuhan No. 1 Hospital ^Wuhan 430022 ,ChinaAbstract Objective To investigate the safety and efficacy of digital subtraction angiography(DSA)-guided neurolysis of posterior ramus of lumbar spinal nerve on old patients with facet-joint-related lumbar pain. Methods A total of 148 patients with chronic low back pain were enrolled in this study from July 2016 to July 2018, in Wuhan No. 1 Hospital. All the patients were randomly divided into 2 groups:neurolysis group(n = 76)and drug group(?? = 72). In the neurolysis group?an epidural nee-dle in disposable epidural anaesthesia puncture kit under DSA was used for neurolysis of posterior rami of lumbar spinal nerve. In drug group,patients received the conservative treatment of oral non-steroidal anti-inflammatory drugs(NSAIDs). Visu-al analogue scores( VAS), Roland-Morris Questionnaire( RMQ) and Oswestry disability Index(ODI) were used to assess pain control and lumbar function before therapy?and at 1 month and 6 months after treatment. Results This was the first report a- bout the DSA-guided neurolysis of posterior ramus of lumbar spinal nerve in old patients with facet-joint-related lumbar pain. VAS in the neurolysis group was significantly lower than that in the drug group at 1 month and 6 months after the treat- ment[(3. 4+1. 1) vs. (4. 0 士 1.3),P = 0. 013；(2. 9 士 1. 1) vs. (4. l±1.3),PV0. 001]. Similarly, RMQ score and ODI score in release group were significantly lower than those in the drug group (all PV0. 05 )? No patients in the neurolysis group had numbness and infection in the innervation area of the treated nerves. Conclusion DSA-guided neurolysis of posterior ramus of lumbar spinal nerve can effectively relieve pain symptoms and improve lumbar function in old patients with facet-joint-related lumbar pain. Additionally?this treatment is safe and has no side effects? thus deserving promoting.Key words lumbar facet joint； posterior ramus spinal nerve； release； lumbar function小关节源性腰痛是引起老年患者慢性腰痛的主 要原因之一，是由于腰椎退变，小关节骨质增生、失
现，约5%?10%的老年人患有由腰椎小关节病变 引起的慢性腰背痛，占老年人群腰痛病因的
稳、变形引起的脊神经后支卡压等造成的。研究发
*武汉市卫生计生委科研项目(No. WX17D04)冯 丹，男，1973 年生，副主任医师,E-mail： 13995621216@163. com △通讯作者?Corresponding author,E-mail:lsjmandoctor@ 163. com60%2幻。腰背部顽固的、反复的慢性疼痛可造成患
者生活质量下降，丧失劳动能力.甚至影响患者睡眠 质量，导致抑郁、焦虑⑷。目前.关于小关节源性腰
痛的治疗方法较多，如保守治疗，介入治疗等。保守
DSA引导下腰脊神经后支松解治疗老年患者小关节源性腰痛的临床研究 - 论文
