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1、實(shí)用疼痛學(xué)雜志2013年8月第9卷第4期PainClinJ,August2013,Vo1.9,No.4277.經(jīng)驗(yàn)交流.經(jīng)骶后孔穿刺硬膜外前間隙置管注藥治療腰椎間盤突出癥林長志馬松鶴【摘要】目的研究經(jīng)骶后孔穿刺前間隙置管注射膠原酶治療腰椎間盤突出癥的可行性。方法腰椎間盤突出癥患者45例,用硬膜外穿刺針,經(jīng)第1骶后孔進(jìn)針,穿刺人硬膜外側(cè)隱窩。在x線透視下循前間隙置入帶鋼絲的硬膜外導(dǎo)管至椎問盤突出壓迫處,經(jīng)注藥試驗(yàn)和造影確認(rèn)穿刺到位后以微量泵泵入膠原酶1200U。觀察穿刺成功的例數(shù)與治療后I5d評(píng)價(jià)患者疼痛緩解情況。結(jié)果應(yīng)用此法在硬膜外前間
2、隙置管45例全部成功。注射膠原酶I5d后患者疼痛消除率6O(27/45例),緩解率4O(18/45例),總有效率100(45/45例)。結(jié)論經(jīng)第1骶后孔穿刺硬膜外置管可準(zhǔn)確地到達(dá)硬膜外前間隙,能有效消除腰椎間盤突出癥患者的疼痛。【關(guān)鍵詞】骶后孔;穿刺術(shù);硬膜外前間隙;置管術(shù)IntubationandinjectiontotheanteriorepiduralspaceviaposteriorsacralforamenforthetreatmentoflumbarintervertebraldischerniationLJNChang--
3、zhi,MASong-he.DepartmentofA8s£^8s0Z0g,StaifHospitalofGanbaoCompa—ny,Baiyin,GansuProvince730900,China[Abstract]0bjectiveToexplorethepossibilityofpuncturing,intubatingandinjectingcolla—genasetotheanteriorepiduralspaceviaposteriorsacralforamenforthetreatmentoflumbarinterver
4、—tebraldischerniation.MethodsForty—fivepatientswithlumbarintervertebraldischerniationwerereceivedepiduralpuncturetothelateralrecessthroughfirstposteriorsacralforamen,thentheepi—duralcatheterwasintubatedtOthetargetunderX—ray,collagenase1200Uwaspumpedintoepi—duralspaceafte
5、ridentificationbyinjectiontrialandradiography.Thenumberofsuccessfulcaseswasrecorded,andpainreliefwasevaluatedat15daysafterthetreatment.ResultsAllthecasesweresuccessfullyintubated.Thecure,improvedandtotaleffectiverateswere60(27/45cases),40(18/45cases)and100(45/45cases)res
6、pectively.ConclusionTheanteriorepiduralspacecanbeexactlypuncturedandintubatedviafirstposteriorsacralforamenforthetreatmentoflumbarinter—vertebra1discherniationafterinjectingcollagenase.[Keywords]Posteriorsacralforamina;Punctures;Anteriorepiduralspace;Catheterization經(jīng)骶裂孔硬
7、膜外前間隙穿刺置管注藥治療腰椎膜外前間隙置管法,從2007年至2012年5月成功間盤突出癥可取得良好的療效,但由于穿刺徑路應(yīng)用于腰椎間盤突出癥45例的治療,現(xiàn)報(bào)告如下。長,解剖變異多,約9.0為鉤形和中部狹窄形骶管,穿刺置管失敗率高。為提高穿刺置管的成功方法率,作者設(shè)計(jì)經(jīng)骶后孔(一般為第1骶后孔)穿刺硬穿刺徑路的解剖學(xué)觀察15例尸體骶骨及腰D0I:10.3969/j.issn.1672—9633.2013.04.010椎的標(biāo)本,經(jīng)測量得出第1骶后孔上緣距L~S作者單位:730900甘肅省白銀市甘寶公司職工醫(yī)院麻醉科(林長志);45000
8、3河南省人民醫(yī)院疼痛科(馬松鶴)硬膜外間隙3~4C1TI,而骶裂孔距L~S硬膜外