【摘要】 目的探讨选择性神经根阻滞（selective nerve root block,SNRB）精准定位联合经皮椎间孔镜技术（percutaneous transforaminal endoscopic discectomy,PTED）治疗多节段腰椎侧隐窝狭窄症的可行性和临床疗效。方法 2013年8月～2017年8月92例多节段腰椎侧隐窝狭窄症且责任神经根定位不明确,预先判断可能性最大的责任神经根并行SNRB。单根神经根阻滞后视觉模拟评分（Visual Analogue Scale,VAS）缓解率≥70%视为明确责任神经根,经皮椎间孔镜下减压侧隐窝及责任神经根。采用VAS、日本矫形外科协会（Japanese Orthopaedic Association,JOA）腰腿痛评分和功能障碍指数（Oswestry disability index,ODI）等指标对患者入院时、PTED术后3 d和1年进行评估。结果 SNRB确定单根责任神经根70例（76. 1%）,具体责任神经根分布情况:L₄ 15例,L₅ 34例,S₁ 21例。术后3 d和1年VAS、JOA评分和ODI较入院时均有明显改善（P <0. 05）。结论 SNRB精准定位联合PTED治疗多节段腰椎侧隐窝狭窄症可行,临床疗效满意。更多还原

【Abstract】 Objective To evaluate the feasibility and clinical effects of selective nerve root block（ SNRB） combined with percutaneous transforaminal endoscopic discectomy（ PTED） in precisely locating and treating the responsible segment of multisegmental lumbar lateral recess stenosis. Methods From August 2013 to August 2017,there were 92 patients with multi-segmental lumbar lateral recess stenosis,but it was unclear which nerve root caused the symptoms. The most possible nerve root was performed SNRB. If the Visual Analogue Scale（ VAS） relief was more than 70%,we believed that this was the responsible root. Then PTED was performed to decompress the responsible lateral recess and root. The VAS,Japanese Orthopaedic Association Scores（ JOA）,and Oswestry Disability Index（ ODI） were used to evaluate the clinical symptoms of patients at admission,the 3 day and 1 year after PTED. Results Owing to SNRB,70 cases（ 76. 1%） of single responsible nerve root were identified,and the responsible segments were as follows: L₄ 15 cases,L₅ 34 cases,S₁ 21 cases. There were significant differences in VAS,JOA scores and ODI between prePTED and post-PTED both 3 day and 1 year after operation（ P < 0. 05）. Conclusion Precisely locating and treating the responsible segment of multi-segmental lumbar lateral recess stenosis by using SNRB combined with PTED can obtain satisfied clinical effects.更多还原