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不同造影剂分布模式下CT引导下根管周围注射的治疗效果

Treatment Effect of CT-Guided Periradicular Injections in Context of Different Contrast Agent Distribution Patterns.

作者信息

Reuschel Vera, Scherlach Cordula, Pfeifle Christian, Krause Matthias, Struck Manuel Florian, Hoffmann Karl-Titus, Schob Stefan

机构信息

Institut für Neuroradiologie, Universitätsklinikum Leipzig AöR, Liebigstr. 20, 04103 Leipzig, Germany.

Institut für Diagnostische und Interventionelle Neuroradiologie, Universitätsmedizin Göttingen, Robert-Koch-Str. 40, 37075 Göttingen, Germany.

出版信息

Diagnostics (Basel). 2022 Mar 23;12(4):787. doi: 10.3390/diagnostics12040787.

Abstract

Acutely manifesting radicular pain syndromes associated with degenerations of the lower spine are frequent ailments with a high rate of recurrence. Part of the conservative management are periradicular infiltrations of analgesics and steroids. The purpose of this study is to evaluate the dependence of the clinical efficacy of CT-guided periradicular injections on the pattern of contrast distribution and to identify the best distribution pattern that is associated with the most effective pain relief. Using a prospective study design, 161 patients were included in this study, ensuring ethical standards. Statistical analysis was performed, with the level of statistical significance set at = 0.05. A total of 37.9% of patients experienced significant but not long-lasting (four weeks on average) complete pain relief. A total of 44.1% of patients experienced prolonged, subjectively satisfying pain relief of more than four weeks to three months. A total of 18% of patients had complete and sustained relief for more than six months. A significant correlation exists between circumferential, large area contrast distribution including the zone of action between the disc and affected nerve root contrast distribution pattern with excellent pain relief. Our results support the value of CT-guided contrast injection for achieving a good efficacy, and, if necessary, indicative repositioning of the needle to ensure a circumferential distribution pattern of corticosteroids for the sufficient treatment of radicular pain in degenerative spine disease.

摘要

与下脊柱退变相关的急性神经根性疼痛综合征是常见疾病,复发率高。保守治疗的一部分是神经根周围注射镇痛药和类固醇。本研究的目的是评估CT引导下神经根周围注射的临床疗效对造影剂分布模式的依赖性,并确定与最有效的疼痛缓解相关的最佳分布模式。采用前瞻性研究设计,本研究纳入了161例患者,确保符合伦理标准。进行了统计分析,设定统计学显著性水平为α = 0.05。共有37.9%的患者经历了显著但不持久(平均四周)的完全疼痛缓解。共有44.1%的患者经历了超过四周至三个月的延长的、主观上令人满意的疼痛缓解。共有18%的患者获得了超过六个月的完全且持续的缓解。包括椎间盘与受影响神经根之间的作用区域在内的圆周形、大面积造影剂分布模式与优异的疼痛缓解之间存在显著相关性。我们的结果支持CT引导下造影剂注射对于实现良好疗效的价值,并且在必要时,对针进行指示性重新定位,以确保皮质类固醇的圆周分布模式,从而充分治疗退行性脊柱疾病中的神经根性疼痛。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/f358/9028051/744fc1d6e4ab/diagnostics-12-00787-g001.jpg

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