Based Pacs Image Measurement Techniques In The Treatment Of Pain

Application of Image-guidance Based on PACS in the Management of Pain Picture archiving and communication system (PACS) was developed rapidly in recent years with advances in digital imaging technology, computer technology and network technology, to meet the need of modernization and digitization of the hospital. Its aims include building the medical image acquisition, display, storage, transmission and management system in hospital. PACS is characterized by information technology, networking, and image transmission quality without distortion and the image information can be shared. PACS is an important part of the medical information system, which composes a digital hospital information environment with Radiology Information System (RIS) and Hospital Information System (HIS). PACS can provide not only medical image acquisition and sharing, but also rich image processing tools with PACS image workstation, through which physicians can make detailed and accurate image measurement, calculation, image reconstruction, and window width adjustment to promote the accuracy of clinical treatment.Nerve block is a technique that using chemical or physical methods around the nerve ganglion, roots, plexus, trunks or terminals to block nerve conduction temporarily or for a long period of time. Nerve block is an important means for pain physicians to manage chronic, intractable pain. It can cut off the vicious cycle of "pain-muscle cramps-ischemia-pain" and relax local blood vessels and muscle cramps of the region innervated by the blocked nerve, improving local blood supply, eliminating of edema, promoting metabolism and loosening adhesions, and then achieving the purpose of the treatment of painful diseases. The success of the management with nerve block depends largely on the accuracy of puncture. In the past, pain physicians performed nerve block "blindly" only with the anatomic landmarks without necessary guidance, which lead to the low accuracy, repeated puncture and larger damage to the patient. PACS image processing functions provide an opportunity to improve the accuracy of the treatment of pain. In this study, we observed the effectiveness of X-ray image-guided block of medial branch of posterior lumbar ramus in the treatment of lumbar facet syndrome and the reliability of MRI images-guided cervical epidural nerve block from the perspective of clinical applications, to explore the significance of the PACS image measurement function in the treatment of pain and to provide more data to the application of image measurement in pain management.This study consists of two parts as follows: Part One:Lumbar X-Ray Image-Guidance Block of Medical Branch of Posterior Lumbar Ramus in the Treatment of Lumbar Facet SyndromeObjective:To observe the effectiveness of X-ray image-guided block of medial branch of posterior lumbar ramus in the treatment of lumbar facet syndrome.Methods:60 patients with clinical diagnosis of lumbar facet syndrome were randomly allocated to either medial branch nerve block group (B) or control group (C). The bilateral block of medial branch of posterior lumbar ramus under the guidance of lumbar X-ray image based on PACS was performed in both groups using 1% lidocaine hydrochloride (containing compound betamethasone injection lml and mecobalamin 500μg) respectively. The effectiveness of the block was assessed by visual analogue scale (VAS) and lumbar activity at 5 min,1,2 and 4 week after block. The complications, if any, were recorded.Results:The difference of pre-block VAS score between both groups was not significant (P>0.05). The VAS score was lower and lumbar activity was greater significantly in both groups at 5 min after block than pre-block baseline value (P<0.05). The VAS score and lumbar activity in group C at 1,2 and 4 week after block were similar with pre-block baseline value (P>0.05), but VAS score was lower and lumbar activity was greater significantly in group B (P<0.05). Though there was no significant difference in VAS score and lumbar activity at 5 min after block between both groups (P>0.05), the VAS score was lower and lumbar activity was greater significantly in group B than that in group C (P<0.05). There was not any complication occurred in both groups. Conclusion:in outpatient lacking of X-ray equipment, X-ray image-guided based on PACS block of medial branch of posterior lumbar ramus is an effective procedure for treatment of lumbar facet joint syndrome.Part Two:Application of MRI Image Guidance in Cervical Epidural Nerve BlockObjective:To observe the effectiveness of MRI image-guided block of cervical epidural nerve.Methods:60 patients with chronic pain requiring cervical epidural nerve block were randomly allocated to either MRI image-guided epidural nerve block group (M) or blindly epidural nerve block group (B). For group M, the parameters of epidural nerve block were got from cervical MRI image measurement before the procedure. And then, epidural nerve block was performed. For group B, cervical epidural nerve block was performed blindly without image measurement. The number of attempts, puncture time and adverse events during the whole procedure were recorded.Results:The number of attempts, puncture time, incidence of nerve root irritation symptoms during the procedure and post-procedure pain of the back of neck were all lower significantly than group B (P<0.05). There was not any severe complication including subarachnoid injection, epidural hematoma or epidural infection occurred In both groups.Conclusion:Compared with "blind" cervical epidural nerve block, cervical MRI image-guided epidural nerve block can decrease the number of attempts, shorten puncture time, avoid puncturing blindly and improve the success.