Wen Chuan-Bing, Li Yong-Zhong, Sun Lin, Xiao Hong, Yang Bang-Xiang, Song Li, Liu Hui
Sichuan Da Xue Xue Bao Yi Xue Ban. 2014 Jul;45(4):712-6.
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.
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.
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 > or = 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).
The ultrasound-guided lumbar facet joint injection technique had a high feasibility and accuracy, and had better clinical efficacy than block blindly.
探讨超声引导下腰椎小关节注射及神经阻滞治疗小关节源性下腰痛的可行性及临床疗效。
将20例小关节疼痛患者随机分为两组，分别接受盲法阻滞（B组）或超声引导下阻滞（US组）。两组均通过CT确认针尖位置，随后计算准确率。记录视觉模拟评分（VAS）、穿刺时间及一次性穿刺成功率（%）。在阻滞后30分钟、1天、2天、6周记录两组的VAS评分及疼痛缓解率。
US组VAS评分为3.3±0.4，B组为1.2±0.3（P<0.05）。US组穿刺时间为（206±27）秒，B组为（397±31）秒（P<0.05）。超声引导下进行了37次小关节阻滞，其中32次首次穿刺即准确到位。成功率为86.5%。盲法进行了35次小关节阻滞，其中11次首次穿刺即准确到位。成功率为31.4%。两组一次性穿刺成功率差异有统计学意义（P<0.05）。B组和US组小关节注射后半小时的VAS及疼痛缓解率差异有统计学意义（P<0.05）。US组分别有8、9、9、9例患者在操作后30分钟、1天、2天、6周时VAS评分降低≥3分，而B组此类患者数量分别为5、6、5、5例（P>0.05）。随访6周后，US组总体缓解率为（72.3±14.0）%，B组为（56.7±11.0）%，两组间差异无统计学意义（P>0.05）。
超声引导下腰椎小关节注射技术具有较高的可行性和准确性，且临床疗效优于盲法阻滞。
