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目的评估实时超声与CT融合成像引导选择性腰骶神经根阻滞治疗的可行性及有效性。方法选取在我院疼痛科行单侧腰4、5及骶1神经根阻滞治疗患者40例,将患者随机分为两组,分别行超声-CT融合成像引导与单独超声引导穿刺,并由X线透视辅助调整穿刺针的位置,分别记录两组引导穿刺总时间及X线透视次数。穿刺到位后由疼痛科医师进行序贯治疗,两组后续治疗方法和治疗药物相同。结果 40例患者均成功引导穿刺。超声融合成像组穿刺过程总时间为13~18min,平均(15.7±1.4)min;融合成像时间为4~8min,平均(6.9±1.3)min;融合成像配准误差3.0~5mm,平均(4.1±0.61)mm;超声最后显示穿刺针尖距靶点距离D为1.2~2.2cm,平均(1.60±0.25)cm;X线透视次数3~5次,平均(3.9±0.8)次。单独超声引导组穿刺过程总时间为9~21min,平均(16.4±2.6)min;X线透视次数4~8次,平均(6.1±1.1)次。X线照射次数两组差异有统计学意义(t=6.914,P<0.001)。结论实时超声-CT融合成像引导下选择性腰骶神经根阻滞是一种安全、有效的方法。
Objective To evaluate the feasibility and effectiveness of real-time ultrasound and CT fusion in guiding selective lumbosacral nerve root block therapy. Methods Forty patients with unilateral lumbar 4,5 and lumbosacral nerve root block in our department of pain were selected. The patients were randomly divided into two groups, and guided by ultrasound-CT fusion imaging and ultrasound guided puncture respectively. X-ray assisted adjustment of the position of the puncture needle, were recorded two sets of guided puncture total time and X-ray frequency. After the puncture in place by the pain doctor for sequential treatment, follow-up treatment of two groups and treatment of the same drugs. Results All the 40 patients successfully guided the puncture. The time of fusion imaging was 4 ~ 8min with an average of (6.9 ± 1.3) min; the fusion imaging registration error was 3.0 ~ 5mm, the average was (4.1 ± 0.61) mm. Finally, the distance D between the puncture tip and target was 1.2 ~ 2.2cm (average 1.60 ± 0.25cm). The number of X-ray fluoroscopy was 3 ~ 5 times (average 3.9 ± 0.8). The total time of ultrasound guided group was 9-21min, with an average of (16.4 ± 2.6) min; the number of X-ray fluoroscopy was 4-8 times with an average of (6.1 ± 1.1) times. The number of X-ray irradiation had significant difference between the two groups (t = 6.914, P <0.001). Conclusion Real-time ultrasound-CT fusion imaging-guided lumbosacral nerve root block is a safe and effective method.