术前选择性神经根阻滞对经皮椎间孔镜下髓核切除术疗效的影响

The effect of preoperative selective nerve root block on the efficacy of percutaneous endoscopic lumbar discectomy for nucleus pulposus

摘要:

目的：探讨术前选择性神经根阻滞（selective nerve root block, SNRB）对经皮椎间孔镜下腰椎间盘髓核摘除术（percutaneous endoscopic lumbar discectomy, PELD）疗效的影响。方法：选取东部战区总医院疼痛科2023年5月至2024年7月单节段腰椎间盘突出（lumbar disc herniation, LDH）伴神经根性痛患者77例，通过随机数字法分为P组（n=38）与S组（n=39）。P组仅行PELD，S组于PELD术前1天行SNRB治疗。比较两组术前、术后３天VAS评分以及术后３个月VAS评分、JOA评分、ODI指数、SF-36评分、术后并发症和复发率。结果：与术前相比，两组患者术后各时间点VAS评分、ODI指数明显降低， JOA评分、SF-36评分显著升高。与P组比较，S组术后3天时VAS评分，以及术后3个月时的VAS评分、JOA评分、ODI指数、SF-36评分、术后残留腰痛（postoperative residual low back pain, PRLBP）和疼痛反复（recurrent pain）的发生率均具有统计学差异（P＜0.05）；两组术后总体优良率无统计学差异。结论：PELD术前联合SNRB治疗单节段LDH术后短期疼痛缓解显著，术后3个月内残余腰痛与疼痛反复的发生率更低，腰椎功能恢复和生活质量提高更明显。

Abstract:

Objective: To explore the impact of preoperative selective nerve root block (SNRB) on the therapeutic effect of percutaneous endoscopic lumbar discectomy (PELD). Method: A total of 77 patients with single-segment lumbar disc herniation (LDH) accompanied by radicular pain in the Department of Painology,General Hospital of Eastern Theater Command from May 2023 to July 2024 were selected and randomly divided into Group P (n=38) and Group S (n=39) by random number method. Group P underwent PELD only, while Group S received SNRB treatment one day before PELD. The VAS scores before and 3 days after surgery, as well as the VAS scores, JOA scores, ODI index, SF-36 scores, postoperative complications, and recurrence rate 3 months after surgery were compared between the two groups. Results: Compared with the preoperative status, the VAS scores and ODI index of both groups significantly decreased at each postoperative time point, and the JOA scores and SF-36 scores significantly increased. Compared with Group P, the VAS score at 3 days after surgery, as well as the VAS score, JOA score, ODI index, SF-36 score, the incidence of postoperative residual low back pain (PRLBP) and recurrent pain 3 months after surgery in Group S showed statistically significant differences(P<0.05); there was no statistically significant difference in the overall excellent rate between the two groups. Conclusion: The combination of SNRB before PELD for single-segment LDH leads to significant short-term pain relief after surgery, a lower incidence of residual low back pain and recurrent pain within 3 months, and more obvious improvement in lumbar function recovery and quality of life.