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文传兵, 李永忠, 孙琳等. 超声引导腰椎小关节阻滞的临床疗效研究[J]. koko体育app 学报（医学版）, 2014, 45(4): 712-716.
引用本文: 文传兵, 李永忠, 孙琳等. 高周波视情况加以引导颈椎小关节软骨阻滞的临床药学治疗效果科研[J]. 湖南专科大学学报（中医学版）, 2014, 45(4): 712-716.
WEN Chuan-bing, LI Yong-zhong, SUN Lin. et al. A Clinical Trial of Ultrasound-guided Facet Joint Block in the Lumbar Spine to Treat Facet Joint Related Low Back Pain[J]. Journal of Sichuan University (Medical Sciences), 2014, 45(4): 712-716.
Citation: WEN Chuan-bing, LI Yong-zhong, SUN Lin. et al. A Clinical Trial of Ultrasound-guided Facet Joint Block in the Lumbar Spine to Treat Facet Joint Related Low Back Pain[J]. Journal of Sichuan University (Medical Sciences), 2014, 45(4): 712-716.

超声引导腰椎小关节阻滞的临床疗效研究

A Clinical Trial of Ultrasound-guided Facet Joint Block in the Lumbar Spine to Treat Facet Joint Related Low Back Pain

  • 摘要: 目的 探讨超声引导腰椎小关节阻滞的可行性、准确性及临床疗效。 方法 选择符合纳入和排除标准的腰椎小关节源性下腰痛患者20例，随机分为超声组和盲穿组，每组10例，分别用超声引导和盲穿的方法进行小关节阻滞，观察患者穿刺时疼痛VAS评分、穿刺时间及一次性穿刺成功率（CT证实），观察患者穿刺前及穿刺后30 min、1 d、2 d、6周时的VAS评分和疼痛缓解率〔(穿刺前VAS评分-穿刺后VAS评分)/穿刺前VAS评分〕、VAS评分减少≥3分及疼痛缓解率≥50%的患者数。结果 盲穿组穿刺时疼痛VAS评分为（3.3±0.4）分，超声组为（1.2±0.3）分，差异有统计学意义（P<0.05）。超声组及盲穿组穿刺时间分别为（206±27） s和（397±31） s，两组差异有统计学意义（P<0.05）。超声组共进行了37个小关节的阻滞，一次性穿刺成功者共32个，成功率达86.5%。盲穿组共进行了35个小关节的阻滞，一次性穿刺成功者共11个，成功率为31.4%。两组成功率比较差异有统计学意义（P<0.05）。两组在穿刺后30 min的VAS评分和缓解率比较差异有统计学意义（P<0.05），余时点两组比较差异无统计学意义（P>0.05）。超声组在穿刺后各时点，VAS评分减少≥3分的患者数分别为8、9、9、9例，而盲穿组分别为5、6、5、5例，两组比较差异无统计学意义（P>0.05）。超声组在穿刺后各时点，疼痛缓解率≥50%的患者数分别为7、8、8、8例，而盲穿组分别为4、5、5、5例, 两组比较差异无统计学意义（P>0.05）。6周后随访，超声组总体缓解率为（72.3±14.0）%，而盲穿组为（56.7±11.0）%，两组比较差异无统计学意义（P>0.05）。结论 超声实时引导穿刺针进行腰椎小关节阻滞的准确性高，疼痛更轻微，耐受性更佳，可以缩短穿刺时间，且在穿刺后30 min的疗效优于盲穿。  
    Abstract: Objective To determine the feasibility and clinical efficacy of ultrasound-guided facet joint injection and nerve block in lumbar facet joint for the treatment of facet-joint related low back pain. Methods 20 patients with facet-joint pain were randomized into two groups received block blindly（B group) or guided by ultrasound (US group) respectively. The location of needle tip was confirmed by CT in both groups, and the accuracy was computed afterwards. VAS score, puncture time and one-time puncture success rate（%) were recorded. VAS scores and pain remission rates in both groups were recorded at 30 min, 1 d, 2 d, 6 weeks after the block. Results The VAS scores were 3.3±0.4 in US group and 1.2±0.3 in B group (P<0.05). The puncture time was (206±27) s in US group while (397±31) s in B group (P<0.05). There were 37 facet joint blocks guided by ultrasound, in which 32 were correctly targeted with the first puncture. The success rate is 86.5%. There were 35 facet joint blocks blindly, in which 11 were correctly targeted with the first puncture. The success rate is 31.4%. The difference of one-time puncture success rate between the two groups was significant (P<0.05). Differences of VAS and pain remission rate at half an hour after facet joint injection between B group and US group were significant (P<0.05). There were 8， 9， 9, and 9 patients in US group obtaining a reduction in VAS scores≥3 at 30 min, 1 d, 2 d and 6 weeks after the procedure respectively, while the numbers of such patients were 5, 6, 5, 5 in B group (P>0.05). After 6 weeks of follow-up, the overall remission rates were (72.3±14.0)% in US group, and (56.7±11.0)% in B group, there was no significant difference between the two groups (P>0.05). Conclusion The ultrasound-guided lumbar facet joint injection technique had a high feasibility and accuracy, and had better clinical efficacy than block blindly.  
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