CT引导下选择性脊神经背根节射频热凝治疗带状疱疹后遗神经痛  

Selective percutaneous dorsal root ganglion radiofrequency thermocoagulation guided by CT scanning in treatment of post-berpetic neuralgis

作　　者：黄冰[1] 周煦燕[1] 陆雅萍[1] 祝则峰[1] 侯健[1] 孙建良[1] 谢国水 祝胜美[3] 郑汉光[4] 

机构地区：[1]嘉兴医学院附属嘉兴市第一医院麻醉、疼痛诊疗科,314000 [2]浙江省武警总队医院麻醉科 [3]浙江大学附属第一医院麻醉科 [4]浙江中医药大学附属中西医结合医院麻醉科

出　　处：《中华医学杂志》2008年第13期885-888,共4页National Medical Journal of China

基　　金：嘉兴市科技局资助项目（2005AY3018）

摘　　要：目的介绍CT引导下选择性脊神经背根节射频热凝治疗带状疱疹后遗神经痛（PHN）的技术。方法CT引导下向相应椎间孔上1／3穿刺，当针尖解剖定位于该椎间孔上1／3时，行阻抗及电刺激感觉、运动的生理功能定位和低温预热确认，最后给予90℃、90s、3个周期的射频热凝治疗。结果16例顽固性PHN患者接受了治疗，均于CT引导下选择性找到靶神经的总计45个背根节，射频热凝治疗后患者的痛、触觉过敏（触发痛）立即消失，5例仍有残余自发痛，但发作频率显著减少，疼痛程度减轻，VAS由术前7～9分降至2～3分，随访2～16个月无复发。结论选择性脊神经背根节射频热凝技术有望成为治疗顽固性PHN的有效手段。Objective To present the experience in a technique used to treat intractable postherpetic neuralgia （PHN）-percutaneous dorsal root ganglion （DGR） radiofrequency thermocoagulation guided by CT scanning. Methods Sixteen PHN patients underwent puncture of radiohealing needle into the superior 1/3 of the corresponding intervertehral foramen guided by CT. Electric stimulation test and impedance test were conducted to confirm the right spot. Radiofrequency heat coagulation therapy under the condition of 90℃ 90 s was performed for 3 cycles. Then mixture of betamethasone and lidocain was injected and the needle was pulled out. CT was conducted to observe if pneumothorax occurred. The patients were followed up for 2 - 16 months. Results Radiofrequency thermocoagulation was performed on 45 target dorsal root ganglia in 16 PHN patients with the effect of immediate disappearance of hyperalgesia. Remaining spontaneous pain was seen in 5 cases, however, with decreases of attack frequency and severity. The visual analogue pain scale score was decreased from 7 -9 before the procedure to 2 -3 after the procedure. No relapse was found during the follow-up. Conclusion Selective percutaneous DRG radiofrequency thermocoagulation guided by CT scanning is effective in treatment of PHN.

关 键 词：疼痛 治疗 疱疹 带状 神经痛 射频热凝 

分 类 号：R686[医药卫生—骨科学]