超声引导下“一针两点法”在腰脊神经后内侧支阻滞中的应用

EFFICACY OF ULTRASOUND-GUIDED POSTERIOR MEDIAL BRANCH BLOCK OF LUMBAR NERVE USING A “TWO-POINTS VIA ONE PUNCTURE” APPROACH

摘要:

目的：观察超声引导下“一针两点法”阻滞腰椎脊神经后内侧支在临床实践中的可行性和有效性。方法：选取拟行腰椎脊神经后内侧支阻滞（lumbar medial branch block, LMBB）患者40名。对所有患者行超声引导下LMBB,其中L4和L5MBB采用“一针两点法”。记录单侧L4和L5MBB治疗完成时间，治疗前、治疗后1小时和治疗后2周的视觉模拟评分（visual analogue scale, VAS）,计算单次治疗总体有效缓解率和整个疗程总体有效缓解率。结果：所有患者均顺利完成超声引导下LMBB，单侧完成L4+L5MBB治疗时间276±61s。单次治疗后1小时和治疗后2周VAS评分均显著下降（P<0.05），整个疗程总体有效缓解率为85%。结论：“一针两点法”解决了目前超声引导下L5MBB实践操作中存在的困难，提高有效性和安全性，有着良好的临床应用前景。

Abstract:

Objective: To observe the clinical feasibility and efficacy of a novel approach of ultrasound-guided " two-points via one puncture " in blocking the posterior medial branch of lumbar spinal nerve. Methods: Forty patients were included to be treated with ultrasound-guided lumbar medial nerve block (LMBB). L4 and L5 MBB were adopted the " two-points via one puncture " approach. The total time to perform the unilateral L4 and L5 MBB and visual analogue scale (VAS) scores before treatment, 1 hour after treatment and 2 weeks after treatment were recorded. Overall effective response rate were calculated after a single treatment and at the end of the treatment course. Results: All the LMBB performances were successfully finished under the ultrasound guidance. The performance time of unilateral L4+L5MBB using “two-points via one puncture " approach was 276±61s. Compared with before treatment, VAS scores decreased significantly at 1 hour and 2 weeks after treatment (P<0.05), and the overall effective response rate of the total treatment course was 85%. Conclusion: The optimized ultrasound-guided " two-points via one puncture " approach of L4+L5MBB solves the difficulties encountered in the practice of ultrasound-guided L5MBB, ensures the effectiveness and safety of the treatment, and has a good clinical application prospect.