超声引导下骶管硬膜外类固醇注射治疗腰痛和坐骨神经痛的疗效和安全性。

Efficacy and safety of ultrasound-guided caudal epidural steroid injection in patients with low back pain and sciatica.

出版信息

J Back Musculoskelet Rehabil. 2022;35(2):317-322. doi: 10.3233/BMR-200224.

DOI:10.3233/BMR-200224

Abstract

BACKGROUND

Fluoroscopy-guided caudal epidural steroid injection (EDSI) is an option for conservative treatment of low back pain and sciatica; however, repeated exposure to radiation is a concern. With the blind technique, the needle misplacement rate is 30%; hence, ultrasound-guided caudal EDSI is a favored option.

OBJECTIVE

To determine the efficacy of ultrasound-guided EDSI for low back pain and sciatica.

METHODS

One hundred and ten patients with low back pain and sciatica who were unresponsive to conservative treatment, were prospectively recruited. Ultrasound-guided caudal EDSI was administered at 0, 3, and 6 weeks. Visual Analog Scale (VAS) score was recorded at 0, 2, 4, 12, and 24 weeks. Patients completed the Roland-Morris Disability Questionnaire (RMDQ) at pre-injection and 24 weeks post-injection.

RESULTS

VAS was significantly reduced at 2, 4, 12, and 24 weeks (p< 0.01). At 2, 4, 12, and 24 weeks after injection, 20%, 26%, 74%, and 83% of patients displayed > 50% VAS reduction, respectively. The mean pre-injection RMDQ score was 15 and that post-injection at 24 weeks was 7 (p< 0.01). The majority of patients had > 50% reduction in the RMDQ score.

CONCLUSIONS

Ultrasound-guided EDSI was safe and efficacious for low back pain and sciatica treatment at the intermediate follow-up.

摘要

背景

荧光透视引导下的骶管硬膜外类固醇注射（EDSI）是治疗腰痛和坐骨神经痛的保守治疗选择之一；然而，反复接受辐射是一个关注点。在盲法技术中，针尖的错位率为 30%；因此，超声引导下的骶管 EDSI 是首选方法。

目的

确定超声引导下 EDSI 治疗腰痛和坐骨神经痛的疗效。

方法

前瞻性招募 110 名对保守治疗无反应的腰痛和坐骨神经痛患者。在 0、3 和 6 周时进行超声引导下的骶管 EDSI。在 0、2、4、12 和 24 周时记录视觉模拟量表（VAS）评分。患者在注射前和注射后 24 周完成 Roland-Morris 残疾问卷（RMDQ）。

结果

VAS 在 2、4、12 和 24 周时显著降低（p<0.01）。在注射后 2、4、12 和 24 周时，分别有 20%、26%、74%和 83%的患者 VAS 降低超过 50%。注射前 RMDQ 评分的平均值为 15，注射后 24 周时为 7（p<0.01）。大多数患者的 RMDQ 评分降低超过 50%。