是否为神经根病变还是牵涉痛？腰椎管狭窄症患者的臀部疼痛。

Is It Radiculopathy or Referred Pain? Buttock Pain in Spinal Stenosis Patients.

机构信息

Department of Orthopaedic Surgery, Wonkwang University Hospital, Iksan, Korea.

Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea.

出版信息

Clin Orthop Surg. 2019 Mar;11(1):89-94. doi: 10.4055/cios.2019.11.1.89. Epub 2019 Feb 18.

DOI:10.4055/cios.2019.11.1.89

PMID:30838112

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6389522/

Abstract

BACKGROUND

Buttock pain is common, and there are no fixed guidelines for its diagnosis and treatment. This study compared a selective nerve root block and a facet joint block for patients with degenerative spinal disease and buttock pain.

METHODS

Patients with degenerative spinal disease who presented with buttock pain, received a selective nerve root block (group A) or a facet joint block (group B) from June 2017 to September 2017, and were able to be followed up for more than 3 months were prospectively enrolled. Clinical results were assessed using a visual analog scale for comparative analysis.

RESULTS

One day after the procedure, an excellent response was found in 7% and 6% of groups A and B, respectively; a good response was found in 41% and 13% of groups A and B, respectively. Two weeks later, an excellent response was found in 11% and 4% of groups A and B, respectively; a good response was found in 41% and 20% of groups A and B, respectively. Six weeks later, an excellent response was found in 11% and 7% of groups A and B, respectively, and a good response was found in 41% and 20% of groups A and B, respectively. At the final follow-up, more than 47% and 46% of patients showed a good response in groups A and B, respectively. In group A, the visual analog scale score improved compared to the pre-procedure value of 5.01 to 2.74 on day 1, 2.51 at week 2, 2.38 at week 6, and 2.39 at week 12. In group B, the visual analog scale score improved compared to the preprocedure value of 5.24 to 3.94 on day 1, 3.99 at week 2, 3.24 at week 6, and 2.59 at week 12. On day 1 and at weeks 2 and 6, group A showed a significantly better outcome than group B ( < 0.05).

CONCLUSIONS

The selective nerve root block showed superior results up to 6 weeks post-procedure. Considering that the selective nerve root block is effective for treating radiculopathy, the primary cause of buttock pain can be thought to be radiculopathy rather than degenerative changes of the facet joint.

摘要

背景

臀部疼痛很常见，但其诊断和治疗尚无固定的指南。本研究比较了选择性神经根阻滞和关节突关节阻滞治疗退行性脊柱疾病伴臀部疼痛的疗效。

方法

2017 年 6 月至 9 月，对患有退行性脊柱疾病并伴有臀部疼痛的患者进行选择性神经根阻滞（A 组）或关节突关节阻滞（B 组），并进行了 3 个月以上的随访，前瞻性纳入了这些患者。采用视觉模拟评分进行临床疗效比较分析。

结果

术后第 1 天，A、B 两组的优良率分别为 7%和 6%；术后第 2 周，A、B 两组的优良率分别为 11%和 4%；术后第 6 周，A、B 两组的优良率分别为 11%和 7%；末次随访时，A、B 两组的优良率分别为 47%以上和 46%。术后第 1 天，A 组的视觉模拟评分从术前的 5.01 分改善至 2.74 分，第 2 周和第 6 周分别为 2.51 分和 2.38 分，第 12 周为 2.39 分；B 组的视觉模拟评分从术前的 5.24 分改善至 3.94 分，第 2 周和第 6 周分别为 3.99 分和 3.24 分，第 12 周为 2.59 分。术后第 1 天和第 2、6 周，A 组的疗效均优于 B 组（<0.05）。