摘要目的:观察超声引导下腰脊神经后支松解治疗小关节源性腰痛的有效性及安全性。方法:分析2019年9月至2021年9月在武汉市第一医院疼痛科治疗的120例腰椎小关节源性疼痛患者的临床资料。所纳入研究患者随机数字表法分为两组，各60例，超声引导下松解组( n＝60)和数字减影血管造影技术(DSA)引导下松解组( n＝60)。两组分别在超声及DSA引导下采用一次性硬膜外穿刺包中硬膜外穿刺针钝性分离松解腰脊神经后支。采用视觉模拟评分法(VAS)、Oswestry功能障碍指数(ODI)进行治疗前及治疗后1周、1个月及6个月时患者疼痛评分和患者腰椎功能评分。 结果:治疗前两组VAS评分[(5.9±0.8)分比(6.0±0.9)分， F＝1.161， P>0.05]和ODI评分差异均无统计学意义[(72.2±5.8)分比(73.3±6.8)分， F＝1.022， P>0.05]；与治疗前比较，两组在治疗后6个月时，VAS评分[(5.9±0.8)分比(1.9±1.3)分， F＝20.182， P<0.01；(6.0±0.9)分比(1.6±1.2)分， F＝15.654， P<0.01 ]和ODI评分明显降低[(72.2±5.8)分比(37.1±10.0)分， F＝20.643， P<0.01；(73.3±6.8)分比(38.0±10.6)分， F＝8.734， P<0.01]，差异有统计学意义。治疗后1周、1个月和6个月，两组患者VAS评分[(2.2±1.0)分比(2.5±1.4)分， F＝9.923， P>0.05；2.0±1.3)分比(2.1±1.3)分， F＝0.110， P>0.05；1.9±1.3)分比(1.6±1.2)分， F＝0.047， P>0.05]和ODI评分比较[(44.9±5.1)分比(45.5±5.2)分， F＝0.000， P>0.05；38.0±10.6)分比(40.8±9.4)分， F＝0.933， P>0.05；37.1±10.0)分比(38.0±10.6)分， F＝0.001， P>0.05]，差异无统计学意义；治疗后1周、1周、1个月和6个月超声引导组和DSA引导组临床有效率间差异无统计学意义(83.3%比75.0%， χ2＝1.263， P>0.05；91.7%比80.0%， χ2＝3.358， P>0.05；86.7%比78.3%， χ2＝1.143， P>0.05)。但超声引导组的穿刺时间，穿刺次数及手术时间明显低于DSA引导组[(20.2±6.7) min比(26.1±6.0) min， F＝1.035， P<0.001；(2.7±1.4)次比(4.4±1.3)次， F＝0.448， P<0.001；(34.1±8.3) min比(47.0±6.0) min， F＝7.861， P<0.001]。此外，两组患者术中、术后均未发生不良反应。 结论:超声引导下腰脊神经后支松解治疗可有效缓解腰椎小关节源性的腰痛患者症状和改善患者腰部功能状况，与DSA引导下松解治疗效果相当；但超声引导下治疗能够减少穿刺次数、缩短手术时间、更少创伤、无辐射、使用便捷，值得推广。

abstractsObjective:To investigate the safety and efficacy of ultrasound-guided neurolysis of posterior ramus of lumbar spinal nerve on patients with facet-joint-related lumbar pain.Methods:A total of 120 patients with low back pain were enrolled in this study from September 2019 to September 2021, in Wuhan No. 1 Hospital. All the patients were randomly divided into 2 groups: ultrasound-guided group ( n=60) and digital subtraction angiography (DSA)-guided group ( n=60). In the two neurolysis groups, an epidural needle in disposable epidural anaesthesia puncture kit was used for neurolysis of posterior ramus of lumbar spinal nerve. Visual analogue scale (VAS) and Oswestry disability index (ODI) were used to assess pain control and lumbar function before therapy, and at 1st week, 1st month and 6th month after treatment. Chi-square test was used for counting data, and t-test or Mann-whitney U test was used for measuring data. Results:There was no significant difference in VAS scores (5.9±0.8 vs. 6.0±0.9, F=1.161, P>0.05) and ODI (72.2±5.8 vs. 73.3±6.8, F=1.022, P>0.05) between the two groups before treatment. The VAS scores (2.2±1.0 vs. 2.5±1.4, F=9.923, P>0.05; 2.0±1.3 vs. 2.1±1.3, F=0.110, P>0.05; 1.9±1.3 vs. 1.6±1.2, F=0.047, P>0.05) and ODI (44.9±5.1 vs. 45.5±5.2, F=0.000, P>0.05; 38.0±10.6 vs. 40.8±9.4, F=0.933, P>0.05; 7.1±10.0 vs. 38.0±10.6, F=0.001, P>0.05) were significantly reduced in both groups at 1st week, 1st month, and 6th month. At 1st week, 1st month and 6th month after treatment, 83.3%, 91.7%, 86.7% patients in the ultrasound-guided group and 75.0%, 80.0%, 78.3% patients in the DSA-guided group achieved good outcome (83.3% vs. 75.0%, χ2=1.263, P>0.05; 91.7% vs. 80.0%, χ2=3.358, P>0.05; 86.7% vs. 78.3%, χ2=1.143, P>0.05). The operating time in the ultrasound-guided group was significantly shorter [(20.2±6.7) min vs. (26.1±6.0) min, F=1.035, P<0.001; 2.7±1.4 vs. 4.4±1.3, F=0.448, P<0.001; (34.1±8.3) min vs. (47.0±6.0) min, F=7.861, P<0.001). No complication was found in both groups. Conclusion:Ultrasound-guided neurolysis of posterior ramus of lumbar spinal nerve can effectively relieve pain symptoms and improve lumbar function in patients with facet-joint-related lumbar pain. Its efficacy is equal to the DSA-guided neurolysis, while it has less radiation exposure and less puncture trauma.