L2神经根联合经椎间孔硬膜外阻滞治疗盘源性腰痛的临床研究李丽楠1 刘波涛2 刘巍3 樊永冠4 方叶1 马迎存5 司马蕾2△

Clinical study of transforaminal epidural combined L2 nerve root pathway block in the treatment of discogenic low back pain*

摘要:

目的：评价L2神经根联合经椎间孔硬膜外阻滞治疗盘源性腰痛(Discogenic low back pain, DLBP)的临床疗效。方法：采用前瞻性随机对照研究方法,符合纳入标准的慢性盘源性腰痛患者分为对照组和研究组,研究组采用病变间盘节段硬膜外阻滞联合L2神经根阻滞,对照组采用病变间盘节段硬膜外阻滞。评价治疗后第1、3、6个月NRS(Numerical rating scale, NRS)疼痛评分、Oswestry功能障碍指数 (Oswestry Disability Index, ODI)评分。结果：符合纳入标准的DLBP病人共92例,随机分为研究组(n = 46)和对照组(n = 46)。治疗后第1、3个月研究组和对照组NRS评分分别为1.71±0.55 vs. 2.69±0.41,2.22±0.42 vs. 3.23±0.51,两组比较有统计学差异性(P<0.05)。研究组和对照组ODI评分分别为12.22±1.70 vs. 17.36±2.07,16.13±2.05 vs. 20.44±2.92,两组比较有统计学差异性(P < 0.05)。治疗后第6个月,两组NRS、ODI评分差异无统计学意义(P > 0.05)。与基础值相比,两组在第1、第3和第6个月NRS、ODI评分均显著降低(P < 0.001)。结论：经椎间孔硬膜外阻滞能够有效减轻盘源性腰痛,改善运动障碍。联合L2神经根通路治疗较单纯硬膜外阻滞更加有效。

Abstract:

Objective: To evaluate the clinical efficacy of L2 nerve root combined with transforaminal epidural block in the treatment of discogenic low back pain (DLBP). Methods: Patients with chronic discogenic low back pain who met the inclusion criteria were divided into the control group and the study group by a prospective randomized controlled method. The study group accepted transforaminal epidural block at affected intervertebral discs level combined L2 nerve root block, while the control group only accepted transforaminal epidural block. NRS (Numerical rating scale, NRS) pain score and Oswestry Disability Index (ODI) score were recorded before and 1, 3 and 6 months after treatment. Result: A total of 92 DLBP patients who met the inclusion criteria were randomly divided into study group (n = 46) and control group (n = 46). The NRS score of the study group and the control group were 1.71±0.55 vs. 2.69±0.41, 2.22±0.42 vs. 3.23±0.51 respectively at the 1st and the 3rd-month after treatment. And there were statistically significant differences between the two groups (P < 0.05)。The ODI scores of the study group and the control group were 12.22±1.70 vs. 17.36±2.07, 16.13±2.05 vs. 20.44±2.92 respectively at the 1st and the 3rd-month after treatment. And there were statistically significant differences between the two groups (P < 0.05). There was no significant difference in NRS and ODI scores between the two groups (P > 0.05) at the 6th-month after treatment. The NRS and ODI scores of the two groups were significantly decreased at the 1st, the 3rd and the 6th-months (P< 0.01) compared with the base value. Conclusion: Transforaminal epidural block can effectively reduce discogenic low back pain and improve movement disorders. Transforaminal epidural combined with L2 nerve root pathway block is more effective than epidural block alone.