超声引导L3-4胸腰筋膜中层注射对于腰椎术后腰背痛的疗效观察

The Effect of Ultrasound-guided L3-4 Mid-thoracolumbar Fascia Injection on Postoperative Lumbar Back Pain

摘要:

摘要 目的： 比较观察超声引导双侧L3-4胸腰筋膜中层阻滞与双侧L3-4脊神经后内侧支阻滞对于腰椎术后腰背痛的疗效。方法： 采用前瞻性分析，将2018年7月至2018年12月疼痛科门诊治疗的32例腰椎术后腰背痛患者随机等分为胸腰筋膜组（TF组）与脊神经后内侧支（MB组）两组。两组均采用超声引导的方式进行治疗3次为一疗程，每次间隔一周，每次用药均为0.15%罗哌卡因（Naropin®)与1/3支得宝松®混合液共20毫升。记录治疗前与治疗一疗程后同组之间、两组之间的即刻、三月的腰椎活动度（Range of motion,ROM）、疼痛数字分级评分（NRS），并记录治疗前与三月后Oswestry功能障碍指数变化。结果： 两组患者治疗后较治疗前症状均有改善。TF组的治疗后即刻一周、二周、一月、三月的腰椎活动度（ROM）、疼痛数字分级评分（NRS）和Oswestry功能障碍指数变化均较MB组为大（P<0.01）。结论： 超声引导L3-4胸腰筋膜中层阻滞治疗对于腰椎术后腰背痛具有显著疗效，可以明显减轻患者的疼痛程度、改善腰椎活动度与功能障碍程度，提高患者的生活质量，且具有操作方便、不良反应与并发症少的优点。

Abstract:

Abstract Objective: To observe and evaluate the efficacy of ultrasound -guided bilateral L3-4 mid-thoracolumbar fascia injection and bilateral L3-4 medial branch block（MBB） for postoperative lumbar back pain. Methods: This is a prospective study. 32 patients suffering severe postoperative low back pain came to the department of pain management of Shanghai Jiao Tong University Affiliated Sixth People’s Hospital and sought for medical advice between July and December 2018. They were randomly divided into 2 groups: Thoracolumbar Fascia(TF) and Medial Branch(MB).Ultrasound-guided therapy was used in both groups 3 times by one-week interval in the course of treatment.Each injection was administered with the mixture of 0.15% Naropin® and 1/3 Diprospan® 20ml.To record the changes of range of motion,numeric rating scales before and after treatment immediately,3m after the procedure as well.Oswestry disability index was recorded before and 3m after the therapy. Results: The clinical symptoms of all the cases were improved after the therapy.Compared with Group MB,the changes of range of motion,numeric rating scales and Oswestry disability index of Group TF were significantly improved(P<0.01).Conclusion: Ultrasound-guided bilateral L3-4 mid-thoracolumbar fascia block had a significant effect on postoperative low back pain.The pain was reduced while the motion and function even the quality of life were improved.Moreover,this procedure had the advantages of easy operation,fewer adverse reactions and complications.