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目的前瞻性研究内窥镜下腰脊神经背内侧支解剖变异特点,评估内窥镜下腰脊神经背内侧支切断术治疗腰椎关节突关节源性慢性腰痛的效果。方法 2011年4月至2011年10月,共45例慢性腰痛患者,经2次分别使用利多卡因和布比卡因行对照性脊神经背内侧支封闭术证实疼痛80%以上来源于腰椎关节突关节。采用内窥镜下脊神经背内侧支切断术治疗。对脊神经背内侧支走行进行记录、分析。记录不同时间点患者腰痛及牵涉痛的VAS评分,包括封闭前、封闭后、术后1天,3、6、12个月。评估术后12个月时腰椎MacNab功能评分。结果内窥镜下腰脊神经背内侧支存在多种解剖变异,包括走行、粗细、骨膜包裹等变异。内窥镜下腰脊神经背内侧支切断术后腰痛及牵涉痛VAS评分较封闭前均明显降低(P<0.05),而与封闭后腰痛及牵涉痛vAS评分差异无统计学意义(P>0.05)。1年随访MacNab功能评分:优27例,良17例,可1例。无手术并发症发生。结论内窥镜下探查腰脊神经背内侧支可以发现可能存在的解剖变异,内窥镜下脊神经背内侧支切断术可以提高腰椎关节突关节源性慢性腰痛治疗的有效率及疗效维持时间。
Objective To prospectively study the anatomic variation of the dorsal medial branch of lumbar spinal nerves under endoscopy and evaluate the effect of lumbar dorsal medial dorsal branch ligation in the treatment of lumbar arthritis with chronic low back pain. Methods From April 2011 to October 2011, a total of 45 patients with chronic low back pain were treated with lidocaine and bupivacaine for 2 times. Controlled dorsal medial dorsal spinal cord herniation proved that over 80% of the pain originated from the lumbar facet joint . Endoscopic spinal dorsal medial branch cut therapy. Record and analyze the dorsal medial branch of spinal nerve. The VAS scores of low back pain and pain were recorded at different time points, including before closure, after closure, 1 day after operation, 3, 6, and 12 months after operation. Assessment of lumbar MacNab function score at 12 months postoperatively. Results There were many anatomical variations in the dorsal medial branch of lumbar spinal nerves under endoscope, including walking, thickness and periosteum wrapping. The VAS score of lumbago and involved pain after endo-dorsal lumbar dorsal medial lumbar dorsal endoscopic ligation was significantly lower than that before ligation (P <0.05), but no significant difference between lumbago and occlusive pain vAS score after ligation (P> 0.05). One-year follow-up MacNab functional score: excellent in 27 cases, good in 17 cases, 1 case. No surgical complications occurred. Conclusion Endoscopic exploration of the lumbar dorsal medial branch of the lumbar spine can detect possible anatomical variations. Endoscopic dorsal medial branchar spondylectomy can improve the efficacy and duration of treatment of lumbar facet joint-acquired chronic low back pain.