超声引导下椎间孔注射治疗神经根型颈椎病的临床研究*

CLINICAL STUDY ON UTRASOUND-GUIDED CERVICAL TRANSFORAMINAL INJECTION IN TREATMENT OF CERVICAL RADICULOPATHY.ZENG Xian-Zheng, SONG Li, Xiao Hong, YANG Bang-Xiang, ZHENG Bi-Xi, YIN Yan△, LIU Hui△

摘要:

目的：探讨超声引导下颈椎椎间孔注射治疗神经根型颈椎病的准确性、安全性及有效性。方法：采用前瞻性、随机、双盲、对照研究,将2017年12月至2018年12月疼痛科就诊符合纳入标准的神经根型颈椎病患者随机分为CT组、超声组。根据患者神经受累区域确定穿刺节段,在CT或者超声引导下进行颈椎椎间孔注射治疗。通过CT扫描评价药液分布优良率,比较各组穿刺时间,记录穿刺过程中出血情况及注射药物后不良反应的发生情况；评估患者术前及术后的NRS评分。结果：共纳入40例患者、3例失访。完成142个颈椎椎间孔穿刺,两组药液分布优良率(CT组：94.9%,超声组：97.1%)比较无明显统计学差异(P＞0.05)。CT组有4个(5.6%)节段发生血管内注射。两组患者穿刺时间分别为：CT组377.2±182.3s,超声组210.2±63.5s,CT组穿刺时间明显长于超声组(P＜0.001)。两组回抽有血比例(CT组为18.1%,超声组为11.4%)比较无明显统计学差异。CT组中,2例患者发生一过性的不良反应。术后2周,1个月,3个月,超声组NSR评分低于CT组。结论：超声引导下颈椎椎间孔注射准确性与CT一致,安全性更高,能够有效的缓解神经根型颈椎病的患者短期疼痛,值得推广。

Abstract:

Objective：To investigate the accuracy, safety and efficacy of ultrasonic-guided transforaminal injection in the treatment of cervical radiculopathy. Methods: A prospective, randomized, double-blind, controlled study was performed. Patients diagnosed with cervical radiculopathy in pain department from December 2017 to December 2018 randomly divide into two groups (CT group and the ultrasound group). The cervical transforaminal injection was performed under the guidance of CT or ultrasound. The puncture segment was determined according to symptoms and signs and examination of the patients. CT scanning was used to verify the location of the needle tip and observe the distribution of contrast after puncture. The bleeding during puncture and the complication after injection were recorded. The NRS was evaluated at each observation point. Results: A total of 226 segments(37 patients)were performed. The excellent rate of contrast distribution of in CT group was 94.9%and 97.1% in ultrasound group. There was no significant difference between two groups. Intravascular injection occurred in 5.6% segments of CT group. The puncture time of the two groups were 377.2±182.3s in CT group and 210.2±63.5sin ultrasound group. CT group took longer time than the ultrasound group and the difference was statistically significant (P < 0.001). The proportion of bleeding in CT group was18.1%, that in ultrasound group was 11.4%. There was no statistical difference between two groups (P > 0.05). In CT group, temporary adverse reactions occurred in two patients. The NSR score of the ultrasound group was lower than that of the CT group at 2 weeks, 1 month and 3 months after injection. Conclusion: Ultrasound-guided cervical transforaminal epidural block was accurate. It was safer than CT group. Compared with CT, ultrasound-guided cervical transforaminal epidural block has the advantages of shorter puncture time, fewer complication. A short-term pain relieve of cervical radiculopathy was achieved under ultrasound-guided cervical transforaminal epidural block.