| BackgroundWith the changing of life in modern society, mode of life and work changes a lot. The incidence of cervical spondylosis is rising up. And more and more young patients affected by this disease. And international research refers to the cervical intervertebral disc, and degenerative change of joint degenerative nerve, spinal cord, caused by the corresponding performance, vascular damage sympoms and signs. The disease can be divided into five different types of cervical syndrome, cervical spondylosis radiculopathy, vertebral artery type, sympathetic nerve type, mixed type of cervical spondylosis. The highest incidence of cervical spondylosis is cervical spondylosis radiculopathy which can be shown the corresponding nerve root compression(oppression, stretch, inflammatory stimuli)and innervation area dysfunction, reached50%-60%). In recently, there was unable to reach a consensus in the pathogenesis、diagnosis and treatment of cervical spondylosis radiculopathy at home and abroad. Although the study of intervertebal disc degeneration has been to molecular gene level, but the degeneration of the initating and key factors is not clear. On the basis of the degeneration of cervical dynamic and static force balance disorders cause further damage is a hotspot of current research, as while as ultrastructure of the nerve root injury and Chinese Integrative medicine on nerve root repair are also in a preliminary stage. Now some scholars has reported the research of the mechanism and regulation function of intervertebral disc cell apoptosis and signal transduction. The diagnosis of the disease still is given priortiy to symptoms for there is still did not have a reasonable objective indictors. Because of strict surgery requirement, the treatment of this disease is used non-surgical treatment at home and abroad. At present, mainly non-surgical treatments including medications, traction, etc in our country, but most of them have adverse reactions, severe gastrointestinal irritation, The traction is given priority to restore its static equilibrium. But they have a lot of shortcomings, such as most reported by itself before and after contrast, lack of reasonable control, repeatability and relapses more. The nerve root nerve block therapy can reduce swelling, nerve root blockage therapy can be directly reached the injured nerve root to reduce its inflammation and edema. Nerve root block treatment of cervical disease have many years of history, but it is now rarely used because of the high risk and low security. Haemi Jee etal used selectivity of cervical nerve root block guided by ultrasound and the intervertebral foramen injection technique guided by X-ray to observe the distinction on the degree of pain relief, function. The degree of pain relief and function improvement was observedon120patients in2012by Haemi Jee et al. Their therapeutic effects were compared and function improvement in2weeks and12weeks, were observed. VNS (Verbal Numeric Pain Scale, verbal numeric pain score table), NDI (Neck Disability Index, cervical dysfunction table) and effectiveness. The results showed that there was no significant of VNS, NDI score between the two groups in2weeks and12weeks. The results showed that Ultrasound can identify the carotid artery, vertebral artery important blood vessels and avoid damage to these vessels. Under the ongoing domestic common X-ray or CT-guided nerve block some of the treatment, on the one hand can improved the accuracy of the puncture, on the other hand, can reducing the damage of surrounding tissue, improving clinical efficacy in some extent. One problem is that X-ray or CT are expensive, lake of can not get a real-time picture, no portable devices, complex operation, and the medical staff and patients are difficult to avoid radiation damage, so it can not promote its use, and with the development of ultrasound technology, people recognize that ultrasound technology is relatively cheap, noninvasive and it can simultaneously monitor the proliferation of drugs. Ultrasound can not only identify the muscles, ligaments, blood vessels, joints and bone structure, but also to observe tiny nerve. Compared with X-ray and CT, ultrasound can get real-time image, and the operator and patients take no ionizing radiation hazards, therefore it has a wider range of applications, especially for pregnant women and other patients. Ultrasound can observe the diffusion of the liquid as a continuous dynamic images in real-time. It can clearly observe the blood vessels, thereby it can reduce the drugs diverted and puncturing blood vessels and other vascular complications. Ultrasound is more cheaper compared with X-ray or CT and easier to operate. Ultrasound can explore almost all of the plexus and systemic and large peripheral nerves, part of a small diameter. Ultrasound probe can also deep nerve and the corresponding nerves surrounding blood vessels or a combination of landmarks safe and effective blocked. Similarly, the ultrasound probe and also almost all the major body joints and surrounding tissue structures of small epidural space of the spine and other joints and also have more deep study. Currently, ultrasound’s safety has been confirmed and has been used in the nerve block and articular injection. With the development of ultrasound technology, I believe there will be more research on smaller nerve and joint, which will make the treatment of pain a broader outlook. In this study, the C-arm machine needle position to observe the results show that ultrasound-guided group,21cases,11cases of non-ultrasound-guided needle puncture foramen from end to<5mm, but30min after injection, U=26, N group of15patients with alcohol swab to wipe all appear to have the corresponding region of pain and temperature sensation diminish or disappeared, and the liquid may spread to nearby nerve root relevant target.ObjectiveTo evaluate the effect of ultrasound-guided nerve root block for cervical radiculopathy. To spread the ultrasound technology in nerve root type cervical spondylosis in clinical treatment.MethodA total of60patients with cervical radiculopathy were randomly divided into2groups, the ultrasound group (group U) and the non-ultrasound group (group N). VAS was recorded before treatment and30minutes,1week,2weeks,4weeks, and8weeks after treatment. The number of cases of accurate injection and cases with consistency of nerve root injection site and block area, cases with treatment more than2times were also recorded as well as incidence of adverse effects. Efficacy was evaluated at4and8weeks after treatment.ResultsThe cases with VAS<4were increased at each time points after treatment in2groups. Compared with group N, there were significantly more cases with VAS<4in group U30minutes and1week after treatment (P<0.05). Compared with group N, there were more cases of accurate injection and more cases with consistency of nerve root injection site and block area in group U, while there were less cases with treatment times≥2in group U (P<0.05). There was no significant difference in incidence of adverse reactions and efficacy evaluation between the2groups.Statistical methodsSPSS18.0software was used to analyze the statistical data. Measurement data of the experimental data are expressed by Mean±standard deviation(x±s).The data of normally distributed were compared using T test, If the data measurement skewed distribution rank sum test was used to compare to the median [M (Q)], count data were compared using chi-square test, Wilcoxon test level data to P<0.05was considered statistically significant.ConclusionMechanical compression of the nerve roots and cause dorsal root ganglion edema, ischemia, venous stasis, induced dorsal root ganglion compartment syndrome, is one of the risk factors of cervical spondylosis radiculopathy; inflammatory mediators and immune to noxious substances released malignant stimulate receptors is another important mechanism to induce cervical root cause of pain. This research indicates that the cases with VAS≥4were reduced at each time points after treatment at4and8week. The indicate exact effect of anti-inflammatory analgesic injection therapy for patients with cervical radiculopathy. While the number of cases in group U accurate puncture, nerve root injection/block area consistent number of cases and after treatment30min VAS<4number of patients increased significantly, indicating that ultrasound-guided nerve root can significantly improve the accuracy of injection therapy, followed by C-arm results also verified the arm operation.As a visual ultrasound imaging techniques, can identify muscle, blood vessels, nerves and small, precisely because the ultrasonic visualization of blood vessels can be clearly observed, nerves, and the diffusion of the drug needle position, thereby improving the safety of operation, and the accuracy of the injection drug.The results of this research showed that30min、group U VAS<4is significantly more than the number of cases in group N, may be associated with liquid lidocaine infiltration of nerve root lesion accuracy related, indicating that ultrasound-guided injection therapy helps to improve accuracy. After briefly due to lidocaine,1week and treatment, both groups of patients VAS<4before the number of cases compared with treatment significantly increased, indicating that lidocaine compound betamethasone, but not with Samer N and other studies similar results further indicate that the inflammatory response and immune response is induced nerve root type cervical spondylosis important mechanism of pain.The ultrasound-guided nerve root injection has high accuracy and requires less treatment times, which is a safe and reliable visualized therapeutic method. |
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