DSA介导下采用射频热凝去神经支配术治疗腰椎小关节综合征的疗效观察  

The therapeutic effects of radiofrequency thermocoagulation denervation mediated by digital subtraction angiography in lumbar facet joint syndrome

作　　者：李丹枫[1] 王龙[1] 曹经山[1] 万曦[1] 

机构地区：[1]武汉大学人民医院麻醉科,武汉430060

出　　处：《中华物理医学与康复杂志》2006年第10期699-702,共4页Chinese Journal of Physical Medicine and Rehabilitation

摘　　要：目的观察在数字血管减影机(DSA)介导下采用射频热凝去神经支配术治疗腰椎小关节综合征的临床疗效及其可行性。方法选取确诊为腰椎小关节综合征的患者80例,将其随机分为去神经支配组及对照组,每组40例。去神经支配组患者采用经皮射频热凝腰椎小关节去神经支配术治疗,对照组患者则向腰椎小关节腔及内侧支注射含倍他米松及利多卡因的混合液。2组患者分别于治疗前、治疗后30 mln、1d、1周、1个月及6个月时采用目测类比评分法(VAS)疼痛评分；并于治疗后1周、1个月及6个月时分别测定2组患者的Schober指数；同时对2组患者治疗结束半年时的疗效及副作用进行对比。结果去神经支配组患者治疗后各时间点的VAS评分较治疗前均有明显下降(P＜0．01),对照组患者治疗后30 min、1d、1周、1个月时的VAS评分较治疗前明显下降(P＜0．01),但6个月时的VAS评分又接近治疗前水平。去神经支配组治疗结束后1周和6周时的VAS评分显著低于对照组(P＜0．05或0．01)。治疗结束后1个月、6个月时去神经支配组的Schober指数显著大于对照组(P＜0．05和P＜0．01)；而且去神经支配组治疗后6个月时的优良率明显高于对照组(P＜0．01)。2组患者均无一例出现神经根损伤及背部局部皮肤感觉功能缺失等副反应。结论在DSA介导下采用射频热凝去神经支配术治疗腰椎小关节综合征,具有安全、微创、有效、简便、长期疗效好、患者易于接受等优点,值得临床进一步推广、应用。Objective To observe the therapeutic effects and assess the feasibility of radiofrequency thermocoagulation denervation （TRD） mediated by digital subtraction angiography （ DSA ） for patients with lumbar facet joint syndrome （ LFJS）. Methods Eighty LFJS patients were randomly divided into two groups： a denervated group （ group Ⅰ） and a control group （ group Ⅱ）. The lumbar facet joints of the patients in group Ⅰ were treated with TRD, while those in group Ⅱ had their lumbar facet joint cavities injected with the mixture of 1 mg betamethasone and 1 ml lidocaine. All patients were assessed using the Visual Analog Scale （VAS） before treatment and 30 min, 1 d, 1 w, 1 m and 6 m after. Schober values were measured at 1 w, 1 m and 6 m after treatment. The therapeutic effects and side effects were assessed at 6 m after treatment. Results VAS scores in groups Ⅰ and Ⅱ at 30 min, 1 d, 1 w and 1 m after treatment were remarkably lower than before treatment. In addition, those in group Ⅰ 6m after treatment were also significantly lower（P 〈 0.01 ）. Compared with those in the group Ⅱ, VAS scores in group Ⅰ were significantly decreased at 1 m and 6 m after treatment（ P 〈 0.05 and P 〈 0.01, respectively）. The schober values in group Ⅰ at 1 m and 6m were obviously increased in comparison with those in group Ⅱ, while the therapeutic effects in group Ⅰ at 6m after treatment were better than those in group Ⅱ （ P 〈 0.01 ）. There were no side effects, such as injuries to the nerve roots or dysfunctional dermal sensation, in either group. Conclusion TRD, mediated by DSA, has therapeutic effects on LFJS. Such treatment is safe, convenient, and gives long-term pain relief.

关 键 词：腰椎 小关节综合征 射频热凝 去神经支配 

分 类 号：R681.5[医药卫生—骨科学]