Objective To evaluate the value of ultrasound-guided epidural puncture in the patients with chronic axial lower back pain caused by degenerative spinal diseases.Methods One hundred and sixtyeight patients with chronic axial lower back pain caused by degenerative spinal diseases,aged 47-60 yr,with body mass index of 18-25 kg/m2,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,with visual analogue scale score ≥6 and the course of the disease ＞3 yr,undergoing epidural puncture were randomly divided into 3 groups (n=56 each) using a random number table:hand positioning group (group H),X-ray guidance group (group X),and ultrasound guidance group (group U).The puncture site was determined by hand positioning,and the epidural puncture was performed routinely in group H.In X and U groups,the puncture site was determined under the guidance of X-ray and ultrasound,respectively,and then the epidural puncture was performed.The operating time,the number of needle insertion at the puncture site,the number of needle passing through tissues,the successful puncture at 1st attempt,and the occurrence of pain at the puncture site were recorded.Results Compared with group H,the operating time was significantly shortened,the number of needle passing through tissues was significantly decreased,the rate of successful puncture at 1st attempt was significantly increased (P＜0.05),and no significant difference was found in the number of needle insertion at the puncture site in X and U groups (P＞0.05).There was no significant difference in the incidence of pain occurred at the puncture site between the three groups (P＞0.05).Conclusion The efficacy of epidural puncture guided by ultrasound is similar to that guided by X-ray and better than that guided by hand positioning in the patients with chronic axial lower back pain caused by degenerative spinal diseases.%目的 评价退行性脊椎病变致轴向慢性腰背部疼痛患者超声引导硬膜外穿刺术的价值.方法 拟行硬膜外穿刺术的退行性脊椎病变致轴向慢性腰背部疼痛患者168例,年龄47～60岁,性别不限,BMI 18～25 kg/m2,ASA分级Ⅰ或Ⅱ级,VAS评分≥6分,病程超过3年,采用随机数字表法,将其分为3组(n=56):手法定位组(H组)、X线透视引导组(X组)和超声引导组(U组).H组采用手法定位进行硬膜外穿刺间隙的选择,常规进行穿刺,X组和U组分别在X线和超声引导下进行硬膜外间隙的选择和穿刺.记录操作时间、穿刺点进针次数、穿刺针在组织中穿过次数、首次穿刺成功情况和穿刺部位疼痛发生情况.结果 与H组比较,X组和U组操作时间缩短,穿刺针在组织中穿过次数减少,首次穿刺成功率升高(P＜0.05),穿刺点进针次数差异无统计学意义(P＞0.05);X组与U组上述各指标比较差异无统计学意义(P＞0.05);3组间穿刺部位疼痛发生率比较差异无统计学意义(P＞0.05).结论 退行性脊椎病变致轴向慢性腰背部疼痛患者超声引导硬膜外穿刺术的效果与X线透视引导的效果相同,且优于手法定位.
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