选择性神经根阻滞联合单侧双通道内镜治疗多节段腰椎退变性疾病的疗效分析

Efficacy analysis of selective nerve root block combined with unilateral biportal endoscopy in the treatment of multilevel lumbar degenerative disease

摘要:

目的 探讨选择性神经根阻滞联合单侧双通道内镜（UBE）在腰椎多节段术前定位不明确退变性疾病中的应用疗效。方法 选取2022年1月—2024年4月九江一七一医院骨科收治的116例多节段腰椎退变性疾病患者，采用随机数字表法分为观察组和对照组，各58例。对照组患者行UBE手术，观察组在UBE手术前1天行选择性神经根阻滞。记录手术时间、术中出血量、透视次数，并比较两组术前、术后3 d、术后3个月及术后12个月的视觉模拟评分法（VAS）评分和Oswestry功能障碍指数（ODI）功能指数，通过X射线片测量椎间隙高度、椎间孔高度、腰椎前凸角（LL）、融合节段前凸角（SL），并记录并发症发生情况。结果 观察组患者的手术时间、术中出血量和术中透视次数均低于对照组（P <0.05）。观察组与对照组术前、术后1 d、术后3个月、术后12个月的VAS评分比较，采用重复测量设计的方差分析，结果 ①不同时间点VAS评分比较，差异有统计学意义（F =1 759.385，P =0.000）；②观察组与对照组VAS评分比较，差异有统计学意义（F =111.492，P =0.000），观察组VAS评分较低；③两组VAS评分变化趋势比较，差异有统计学意义（F =17.082，P =0.000）。观察组与对照组术前、术后1 d、术后3个月、术后12个月的ODI评分比较，采用重复测量设计的方差分析，结果 ①不同时间点ODI评分比较，差异有统计学意义（F =1 373.734，P =0.000）；②观察组与对照组ODI评分比较，差异有统计学意义（F =237.008，P =0.000），观察组ODI评分较低；③两组ODI评分变化趋势比较，差异有统计学意义（F =36.995，P =0.000）。观察组治疗后椎间隙高度、椎间孔高度、LL、SL均高于对照组（P <0.05）。观察组并发症总发生率低于对照组（χ² =5.841，P =0.016）。结论 选择性神经根阻滞是一种有效和准确地确定责任间隙的方法，联合UBE可以取得良好的疗效。

Abstract:

Objective To investigate the efficacy of selective nerve root block combined with unilateral biportal endoscopy (UBE) in the treatment of multilevel lumbar degenerative disease with unclear preoperative localization.Methods A total of 116 patients with multilevel degenerative lumbar disease admitted to our department from January 2022 to April 2024 were enrolled and randomly divided into two groups using the random number table method, with 58 cases in each group. The control group was treated with UBE alone, while the observation group received selective nerve root block one day prior to UBE surgery. The operative duration, intraoperative blood loss and fluoroscopy frequency were recorded for all patients. The Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were compared between the two groups before surgery and 3 days, 3 months and 12 months after surgery. Radiological parameters including intervertebral space height, intervertebral foramen height, lumbar lordosis (LL) and segmental lordosis (SL) of the fused segments were measured via X-ray. The incidence of adverse events was also documented.Results The observation group showed significantly shorter operative duration, less intraoperative blood loss, and fewer intraoperative fluoroscopy exposures than the control group (all P < 0.05). Repeated-measures analysis of variance (ANOVA) was used to compare VAS scores before surgery and 3 days, 3 months and 12 months after surgery, and the results showed that VAS scores differed significantly over time (F = 1,759.385, P < 0.001) and between the two groups (F = 111.492, P < 0.001), with lower scores in the observation group. The change trend of the VAS scores was different between the two groups (F = 17.082, P < 0.001). For the ODI scores, repeated-measures ANOVA showed that they differed significantly over time (F = 1,373.734, P < 0.001) and between groups (F = 237.008, P < 0.001), with lower scores in the observation group. The change trend of the ODI scores was different between the two groups (F = 36.995, P < 0.001). Postoperative intervertebral space height, intervertebral foramen height, LL, and SL were significantly greater in the observation group than in the control group (all P < 0.05). The incidence of complications was significantly lower in the observation group (χ² = 5.841, P = 0.016).Conclusion Selective nerve root block serves as an effective and accurate method for identifying the responsible intervertebral level, and its combination with UBE can yield favorable clinical outcomes.