| Objective: To explore the best way to accurately perform a located puncture to the lumbar nerve root with ultrasonic visualization technology; to compare the clinical effect of ultrasonic located puncture block with the traditional puncture block and radiological model guide; to define the safety and superiority of the technology of selective lumbar nerve root block with two-dimensional imaging of ultrasonic scan; to provide a certain theoretical basis for the feasibility of the clinical ultrasonically-visualized nerve-block treatment for the patient with lumbsacral radicular pain.Method: 90 cases of patients who need to accept selective lumbar nerve root block were selected. These patients were divided into traditional therapy group(group A), radiologically guided group(group B) and ultrasonically guided group(group C) by the method of single-blind-random, with 30 cases fin each group. The comparison of general condition(according to the selecting and excluding standard) among the groups was not statistically significant(P>0.05).Each group of patients were treated with selective lumbar nerve root block periodically, the blocking drug was a mixed liquid of 0.3% lidocaine, 10 mg triamcinolone acetonide and 0.9% normal saline, the position where the puncture needle enters the therapeutic target was determined by the respective nerve root location method for each group, and the needle was drawn back before checked for abnormality. Then block therapy was performed by injecting with no more than 15 ml drugs based on the patient’s subjective feeling for the radioactivity. During the treatment, the venous channel was conventionally opened, electrocardiograph monitoring and oxygen uptake was provided to ensure a stable vital sign of the patient. The patient was not allowed to leave until 30 minutes since the treatment was finished without any abnormal reaction. Two to five weeks of continuous treatment may be performed on the patient according to the treatment effect and the situation of pain relief. The interval between each treatment was a week.Observational data index:(1) The general condition of the patient was recorded, a stable vital sign of the patient shall be ensured during the treatment;(2) The segment of the lumbar nerve root selected in each treatment, drug dosage, abnormal reaction during the puncture and whether a bleeding occurred at the puncture point or not were recorded;(3) The patient’s blood was respectively extracted to be refrigerated one week or two before and after the treatment, the plasma TNF-αlevel was detected;(4) The treatment effect and the situation of pain-relieving of the patient was accessed by a regular follow-up visit 1、2、3、6 weeks、3 months and 6 months after the treatment. The accumulative number of treatment the patient received was determined, and whether the relevant complications of patient(infection, hematoma, decreased myodynamia, spinal nerve dystrophia, dysfunction and so on)were treated. The change in pain degree was recorded simultaneously with the method of VAS(Visual Analogue Scale/Score).Result: 1、The comparison of the general data(age, gender, VAS before treatment, nerve root segment treated) among the 3 groups of patient was not statistically significant(P>0.05). 2、 The comparisons of VAS change before treatment and after treatment between the 3 groups were equally statistically significant(P<0.05), the comparison of VAS change after treatment between group A and B was statistically significant(P<0.05), the comparison of VAS change after treatment between group A and C was statistically significant(P<0.05), the comparison of VAS change after treatment between group B and C was not statistically significant(P=0.675). 3、The comparison of the TNF-α expression before treatment among the three groups was not statistically significant(P>0.05), the comparisons of the TNF-α expression before and after treatment among the three groups were equally statistically significant(P<0.05), the comparison of the TNF-α expression after treatment between group A and B was statistically significant(P<0.05), the comparison of the TNF-α expression after treatment between group A and C was statistically significant(P<0.05), the comparison of the TNF-α expression after treatment between group B and C was not statistically significant(P=0.759), the comparison of the TNF-α expression 3 days and 2 weeks after treatment among three groups was not statistically significant(P>0.05). 4、Number of treatment: compared with group A, the number of treatment of group B and C was clearly reduced, of which the comparison was statistically significant(P<0.05); the comparison of number of treatment between group B and C was not statistically significant(P=0.343).5、Drug dosage: compared with group A, the drug dosage of group B and C was clearly reduced, of which the comparison was statistically significant(P<0.05); the comparison of drug dosage between group B and C was not statistically significant(P=0.147). 6、The rate of inefficiency of the 1st-time segment selection of the three groups was respectively 26.67%,23.33%,26.67%, the comparison among three groups was not statistically significant(P>0.05). The comparison of incidence rate of nerve irritation symptom among three groups was not statistically significant(P>0.05). 7、The incidence rate of local hematoma of group A, B and C was respectively 26.02%,16.92%,7.69%, the respective comparisons among three groups were equally statistically significant(P<0.05)Conclusion: through the technology of selective lumbar nerve root block with two-dimensional imaging of ultrasonic scan, the advantages including non-invasiveness, X-ray irradiation-free, portability, direct use without lots of preparations and easy operation and so on Meanwhile, in the process of operation, the needle insertion can be performed under a direct, continuous and visualized view. The deposition and spread of local anesthetic during the injection can be observed by the real-time ultrasonic image, and the vessels and nerves can be easily identified, the contrast agent can be avoided, the risk of local anesthetic injection in the vessels and nerves can be reduced, the treatment effect of the ultrasonic visualization technology is equivalent to that of radiological image in terms of the guided nerve block, and with more application advantage. It is a environmental protection,visualized, safe and reliable treating technology. |
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