超声引导下经椎间孔硬膜外注射的可行性

doi:10.3969/j.issn.1006-9771.2020.05.011

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (5): 550-554.doi: 10.3969/j.issn.1006-9771.2020.05.011

超声引导下经椎间孔硬膜外注射的可行性

任伟靖^1,^2a,王方永^1,^2a(),洪毅^1,^2a(),郭忆^1,^2b,宋明洁^1,^2a

1.首都医科大学康复医学院,北京市 100068
2.中国康复研究中心北京博爱医院,a. 脊柱脊髓外科;b. 超声科,北京市 100068

收稿日期:2019-10-28 修回日期:2020-01-16 出版日期:2020-05-25 发布日期:2020-05-29
通讯作者: 王方永,洪毅 E-mail:wfybeijing@163.com;hongyihhyy@163.com
作者简介:任伟靖(1994-),女,汉族,河北邯郸市人,硕士研究生,主要研究方向：康复医学与理疗学、脊柱脊髓损伤。
基金资助:
1.首都卫生发展科研专项项目(2018-3-6012);2.中国康复研究中心项目(2017ZX-02);2.中国康复研究中心项目(2017ZX-23)

Ultrasound-guided Transforaminal Epidural Injection in Pigs

REN Wei-jing^1,^2a,WANG Fang-yong^1,^2a(),HONG Yi^1,^2a(),GUO Yi^1,^2b,SONG Ming-jie^1,^2a

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2.a. Department of Spine Surgery; b. Department of Ultrasound, Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing 100068, China

Received:2019-10-28 Revised:2020-01-16 Published:2020-05-25 Online:2020-05-29
Contact: WANG Fang-yong,HONG Yi E-mail:wfybeijing@163.com;hongyihhyy@163.com
Supported by:
Capital Health Development Special(2018-3-6012);China Rehabilitation Research Center Project(2017ZX-02);China Rehabilitation Research Center Project(2017ZX-23)

摘要/Abstract

摘要：

目的观察猪标本超声引导下腰椎经椎间孔硬膜外注射的可行性及准确性。方法取来自2只巴马小型猪的L_1-6节段脊柱及椎旁部分组织,分别在双侧L_1-2、L_2-3、L_3-4、L_4-5、L_5-6椎间孔完成超声引导下经椎间孔硬膜外穿刺,应用腰椎X线片和CT检测穿刺针位置;大体观察穿刺针入路和针尖位置,记录穿刺针皮肤入针点与后正中线距离、入针深度和入针角度,并进行左右对比。结果穿刺成功率95% (19/20),其中穿刺针针尖位于椎间孔下缘、腹侧、中央区和旁中央区的占80% (16/20)。成功穿刺时,左右侧穿刺针皮肤入针点与后正中线距离、入针深度、入针角度无显著性差异(|t| < 1.475, P > 0.05)。结论超声引导下经椎间孔硬膜外穿刺有较高准确率。

关键词: 经椎间孔硬膜外注射, 超声引导, 猪

Abstract:

Objective To observe the feasibility and accuracy of ultrasound-guided transforaminal epidural injection.Methods Ultrasound-guided injection at L_1-2, L_2-3, L_3-4, L_4-5, L_5-6 bilaterally was performed in L_1-6 spine from two Bama miniature pigs. The position of needles was detected with X-ray and CT, and observed under anatomy. The distance from the puncturing points at skin to the posterior midline, the depths and angles of puncturing between were measured and compared bilaterally.Results The successful rate was 95% (19/20), out of which, 80% (16/20) were put the needle tips at the lower part of the intervertebral foramen, ventral side, central region or paracentral region. There was no significant difference between sides in the distances, depths or angles in 19 successful injections.Conclusion It is accurate to transforaminally puncture under ultrasound-guided.

Key words: transforaminal epidural injection, ultrasound-guided, pigs

中图分类号:

R681.5

任伟靖,王方永,洪毅,郭忆,宋明洁. 超声引导下经椎间孔硬膜外注射的可行性[J]. 《中国康复理论与实践》, 2020, 26(5): 550-554.

REN Wei-jing,WANG Fang-yong,HONG Yi,GUO Yi,SONG Ming-jie. Ultrasound-guided Transforaminal Epidural Injection in Pigs[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(5): 550-554.

图/表 5

图1

图2

图3

图4

表1

参考文献 49

[1]	Malfliet A, Ickmans K, Huysmans E, et al. Best evidence rehabilitation for chronic pain part 3: low back pain[J]. J Clin Med, 2019, 8(7):1063. doi: 10.3390/jcm8071063
[2]	Clark S, Horton R. Low back pain: a major global challenge[J]. Lancet, 2018, 391(10137):2302.
[3]	Schiltenwolf M, Schneider S. Activity and low back pain: a dubious correlation[J]. Pain, 2009, 143(1-2):1-2. doi: 10.1016/j.pain.2009.01.027 pmid: 19233563
[4]	Stamm T A, Boesendorfer A, Omara M, et al. Outcomes research in non-specific low back pain: knowledge transfer in clinical practice[J]. Wien Klin Wochenschr, 2019, 131(21-22):550-557. doi: 10.1007/s00508-019-1523-4
[5]	Balagué F, Mannion A F, Pellisé F, et al. Non-specific low back pain[J]. Lancet, 2012, 379(9814):482-491. doi: 10.1016/S0140-6736(11)60610-7
[6]	Maher C, Underwood M, Buchbinder R. Non-specific low back pain[J]. Lancet, 2017, 389(10070):736-747. doi: 10.1016/S0140-6736(16)30970-9
[7]	Kaito T, Matsuyama Y, Yamashita T, et al. Cost-effectiveness analysis of the pharmacological management of chronic low back pain with four leading drugs[J]. J Orthop Sci, 2019, 24(5):805-811. doi: 10.1016/j.jos.2019.06.004
[8]	Hoy D, March L, Brooks P, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study[J]. Ann Rheum Dis, 2014, 73(6):968-974. doi: 10.1136/annrheumdis-2013-204428
[9]	Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally[J]. Spine J, 2008, 8(1):8-20. doi: 10.1016/j.spinee.2007.10.005 pmid: 18164449
[10]	Hashemi M, Dadkhah P, Taheri M, et al. Lumbar transforaminal epidural steroid injection in patients with lumbar radicular pain; outcome results of 2-year follow-up[J]. Bull Emerg Trauma, 2019, 7(2):144-149. doi: 10.29252/beat-070209
[11]	Manchikanti L, Kaye A D, Manchikanti K, et al. Efficacy of epidural injections in the treatment of lumbar central spinal stenosis: a systematic review[J]. Anesth Pain Med, 2015, 5(1):e23139.
[12]	Manchikanti L, Pampati V, Benyamin R M, et al. Analysis of efficacy differences between caudal and lumbar interlaminar epidural injections in chronic lumbar axial discogenic pain: local anesthetic alone vs. local combined with steroids[J]. Int J Med Sci, 2015, 12(3):214-222. doi: 10.7150/ijms.10870 pmid: 25678838
[13]	Pandey R A. Efficacy of epidural steroid injection in management of lumbar prolapsed intervertebral disc: a comparison of caudal, transforaminal and interlaminar routes [J]. J Clin Diagn Res, 2016, 10(7): RC05-11.
[14]	Pountos I, Panteli M, Walters G, et al. Safety of epidural corticosteroid injections[J]. Drugs R D, 2016, 16(1):19-34. doi: 10.1007/s40268-015-0119-3
[15]	Lutz G E, Vad V B, Wisneski R J. Fluoroscopic transforaminal lumbar epidural steroids: an outcome study[J]. Arch Phys Med Rehabil, 1998, 79(11):1362-1366. doi: 10.1016/S0003-9993(98)90228-3
[16]	Botwin K P, Gruber R D, Bouchlas C G, et al. Fluoroscopically guided lumbar transformational epidural steroid injections in degenerative lumbar stenosis: an outcome study[J]. Am J Phys Med Rehabil, 2002, 81(12):898-905. doi: 10.1097/00002060-200212000-00003
[17]	Hurdle M F. Ultrasound-guided spinal procedures for pain: a review[J]. Phys Med Rehabil Clin N Am, 2016, 27(3):673-686. doi: 10.1016/j.pmr.2016.04.011
[18]	Lord S M, Barnsley L, Wallis B J, et al. Chronic cervical zygapophysial joint pain after whiplash. A placebo-controlled prevalence study [J]. Spine (Phila Pa 1976), 1996, 21(15: 1737-1744; discussion 1744-1745. doi: 10.1097/00007632-199608010-00006
[19]	Moult E, Ungi T, Welch M, et al. Ultrasound-guided facet joint injection training using Perk Tutor[J]. Int J Comput Assist Radiol Surg, 2013, 8(5):831-836. doi: 10.1007/s11548-012-0811-5 pmid: 23329279
[20]	Ramlogan R, Niazi A U, Jin R, et al. A virtual reality simulation model of spinal ultrasound: role in teaching spinal sonoanatomy[J]. Reg Anesth Pain Med, 2017, 42(2):217-222. doi: 10.1097/AAP.0000000000000537
[21]	Kwon S Y, Hong S H, Kim E S, et al. The efficacy of lumbosacral spine phantom to improve resident proficiency in performing ultrasound-guided spinal procedure[J]. Pain Med, 2015, 16(12):2284-2291. doi: 10.1111/pme.12870
[22]	Sutherland C, Hashtrudi-Zaad K, Abolmaesumi P, et al. Towards an augmented ultrasound guided spinal needle insertion system[J]. Conf Proc IEEE Eng Med Biol Soc, 2011, 2011:3459-3462.
[23]	de Freitas R M C, Andrade C S, Caldas J G M P, et al. Image-guided cryoablation of the spine in a swine model: clinical, radiological, and pathological findings with light and electron microscopy[J]. Cardiovasc Intervent Radiol, 2015, 38(5):1261-1270. doi: 10.1007/s00270-014-1043-6
[24]	Kelbl M, Kocis J, Vesely R, et al. Biomechanical testing of spinal segment fixed by arcofix system on the swine spine[J]. Asian Spine J, 2015, 9(4):503-510. doi: 10.4184/asj.2015.9.4.503
[25]	Kaye E A, Monette S, Srimathveeravalli G, et al. MRI-guided focused ultrasound ablation of lumbar medial branch nerve: feasibility and safety study in a swine model[J]. Int J Hyperthermia, 2016, 32(7):786-794. doi: 10.1080/02656736.2016.1197972
[26]	Unger M D, Maus T P, Puffer R C, et al. Laminotomy for lumbar dorsal root ganglion access and injection in swine[J]. J Vis Exp, 2017(128):56434.
[27]	Loizides A, Gruber H, Peer S, et al. Ultrasound guided versus CT-controlled pararadicular injections in the lumbarspine: a prospective randomized clinical trial[J]. AJNR Am J Neuroradiol, 2013, 34(2):466-470. doi: 10.3174/ajnr.A3206
[28]	Loizides A, Gruber H, Peer S, et al. A new simplified sonographic approach for pararadicular injections in the lumbar spine: a CT-controlled cadaver study[J]. Am J Neuroradiol, 2011, 32(5):828-831. doi: 10.3174/ajnr.A2389 pmid: 21349957
[29]	Grubb S A, Lipscomb H J, Coonrad R W. Degenerative adult onset scoliosis[J]. Spine (Phila Pa 1976), 1988, 13(3):241-245. doi: 10.1097/00007632-198803000-00004
[30]	Grubb S A, Lipscomb H J, Suh P B. Results of surgical treatment of painful adult scoliosis[J]. Spine (Phila Pa 1976), 1994, 19(14):1619-1627. doi: 10.1097/00007632-199407001-00011
[31]	Jackson R P, McManus A C. Radiographic analysis of sagittal plane alignment and balance in standing volunteers and patients with low back pain matched for age, sex, and size. A prospective controlled clinical study[J]. Spine (Phila Pa 1976), 1994, 19(14):1611-1618. doi: 10.1097/00007632-199407001-00010
[32]	Kantrowitz F, Robinson D R, McGuire M B, et al. Corticosteroids inhibit prostaglandin production by rheumatoid synovial[J]. Nature, 1975, 258(5537):737-739. pmid: 1207758
[33]	Fukusaki M, Kobayashi I, Hara T, et al. Symptoms of spinal stenosis do not improve after epidural steroid injection[J]. Clin J Pain, 1998, 14(2):148-151. pmid: 9647457
[34]	Johansson A, Hao J, Sjolund B. Local corticosteroid application blocks transmission in normal nociceptive C-fibres[J]. Acta Anaesthesiol Scand, 1990, 34(5):335-338. doi: 10.1111/aas.1990.34.issue-5
[35]	Kennedy D J, Zheng P Z, Smuck M, et al. A minimum of 5-year follow-up after lumbar transforaminal epidural steroid injections in patients with lumbar radicular pain due to intervertebral disc herniation[J]. Spine J, 2018, 18(1):29-35. doi: S1529-9430(17)30981-6 pmid: 28962912
[36]	Slipman C W, Chow D W. Therapeutic spinal corticosteroid injections for the management of radiculopathies[J]. Phys Med Rehabil Clin N Am, 2002, 13(3):697-711. doi: 10.1016/S1047-9651(02)00004-9
[37]	Vad V B, Bhat A L, Lutz G E, et al. Transforaminal epidural steroid injections in lumbosacral radiculopathy: a prospective randomized study[J]. Spine (Phila Pa 1976), 2002, 27(1):11-16. doi: 10.1097/00007632-200201010-00005
[38]	Gofeld M, Bristow S J, Chiu S C, et al. Ultrasound-guided lumbar transforaminal injections: feasibility and validation study[J]. Spine (Phila Pa 1976), 2012, 37(9):808-812. doi: 10.1097/BRS.0b013e3182340096
[39]	Yang G, Liu J, Ma L, et al. Ultrasound-guided versus fluoroscopy-controlled lumbar transforaminal epidural injections: a prospective randomized clinical trial[J]. Clin J Pain, 2016, 32(2):103-108. doi: 10.1097/AJP.0000000000000237 pmid: 25803759
[40]	Tecer D, Adiguzel E, Tan A K, et al. Role of magnetic resonance imaging in ascertaining the success of transforaminal epidural steroid injection for lumbar radicular pain[J]. Pain Med, 2017, 18(4):645-650.
[41]	Park J W, Nam H S, Cho S K, et al. Kambin's triangle approach of lumbar transforaminal epidural injection with spinal stenosis[J]. Ann Rehabil Med, 2011, 35(6):833-843. doi: 10.5535/arm.2011.35.6.833
[42]	Jasper J F. Lumbar retrodiscal transforaminal injection[J]. Pain Physician, 2007, 10(3):501-510.
[43]	Lew H L, Coelho P, Chou L H. Preganglionic approach to transforaminal epidural steroid injections[J]. Am J Phys Med Rehabil, 2004, 83(5):378. doi: 10.1097/00002060-200405000-00008
[44]	Kim W J, Shin H Y, Yoo S H, et al. Comparison of epidural spreading patterns and clinical outcomes of transforaminal epidural steroid injection with high-volume injectate via the subpedicular versus the retrodiscal approach[J]. Pain Physician, 2018, 21(3):269-278.
[45]	Murthy N S, Maus T P, Behrns C L. Intraforaminal location of the great anterior radiculomedullary artery (artery of Adamkiewicz): a retrospective review[J]. Pain Med, 2010, 11(12):1756-1764. doi: 10.1111/j.1526-4637.2010.00948.x
[46]	Kambin P, Sampson S. Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results[J]. Clin Orthop Relat Res, 1986, 207:37-43.
[47]	Kambin P. Arthroscopic microdiskectomy[J]. Mt Sinai J Med, 1991, 58(2):159-164. pmid: 1857361
[48]	Kambin P, Savitz M H. Arthroscopic microdiscectomy: an alternative to open disc surgery[J]. Mt Sinai J Med, 2000, 67(4):283-287. pmid: 11021778
[49]	Ignjatovic S, Omidi R, Kubik-Huch R A, et al. The retroneural approach: an alternative technique for lumbar transforaminal epidural steroid injections[J]. Acta Radiol, 2018, 59(12):1508-1516. doi: 10.1177/0284185118762248 pmid: 29523042

组别	d1(mm)	d2(mm)	a(°)
左侧	62.88±4.45	41.37±2.57	21.90±5.97
右侧	63.91±5.25	40.87±4.00	25.78±5.43
t值	-0.461	0.333	-1.475
P值	0.651	0.743	0.158

超声引导下经椎间孔硬膜外注射的可行性

Ultrasound-guided Transforaminal Epidural Injection in Pigs

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 5

参考文献 49

相关文章 2

Metrics

本文评价

推荐阅读 0

[1]	杨瑛,许梅娜,李相良,谢峦,金海鹏. 超声引导下肉毒毒素环咽肌注射治疗延髓背外侧综合征所致吞咽障碍1例报道[J]. 《中国康复理论与实践》, 2020, 26(11): 1358-1364.
[2]	周媛;钱家树;薛灵芝;曹苏;丁晶晶. 右美托咪定腹横肌平面阻滞对腹腔镜结肠根治术后恢复的影响[J]. 《中国康复理论与实践》, 2014, 20(12): 1171-1174.