射频消融治疗脊柱内镜术后椎间盘源性脊神经后支疼痛的疗效分析  

Analysis on therapeutic effect of radiofrequency ablation on discogenic lumbar spinal nerve posterior branch neuralgia after vertebral endoscope surgery

作　　者：云晨[1] 韩广[1] 蒋显锋[1] 田海滨 苗翠云[1] 梁佳敏[2] 符锋[3] 李杰[1] 汤锋武[1] 邰爽 Yun Chen;Han Guang;Jiang Xianfeng;Tian Haibin;Miao Cuiyun;Liang Jiamin;Fu Feng;Li Jie;Tang Fengwu;Tai Shuang(Department of Neurosurgery-4, Affiliated Hospital of Logistics University of People's Armed Police, Tianjin 300162, China;Department of Anesthesiology-2, Affiliated Hospital of Logistics University of People's Armed Police, Tianjin 300162, China;Department of Neurosurgery-1, Affiliated Hospital of Logistics University of People's Armed Police, Tianjin 300162, China;The Xing'an Detachment of the Armed Police Corps in Inner Mongolia, Xing'an 137400, Inner Mongolia, China)

机构地区：[1]武警后勤学院附属医院脑科中心神经外四科,天津300162 [2]武警后勤学院附属医院麻醉二科,天津300162 [3]武警后勤学院附属医院神经外一科,天津300162 [4]武警内蒙总队兴安支队,内蒙古兴安137400

出　　处：《中国中西医结合急救杂志》2018年第6期646-649,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：天津市科技计划项目(15ZXLCSY00040).

摘　　要：目的观察射频消融治疗脊柱内镜术后椎间盘源性脊神经后支疼痛的临床疗效。方法2011年12月至2017年12月武警后勤学院附属医院收治了36例脊柱内镜术后椎间盘源性脊神经后支疼痛患者,按治疗方法不同分为两组,每组18例。射频消融组采用X线影像引导下腰脊神经后支射频热凝术治疗;药物组采用口服双氯芬酸钠保守治疗,每次75mg、每日2次,共3周。两组均随访6个月,用视觉模拟评分法(VAS)评估治疗前后疼痛状况,用Oswestry功能障碍指数评估患者腰部功能恢复程度,观察手术并发症和药物不良反应发生情况。结果两组患者治疗前的VAS评分相当;治疗后1个月两组VAS评分均较治疗前明显降低(分:射频消融组为1.83±0.71比5.67±0.77,药物组为2.22±0.43比5.28±0.67,均P<0.05);而治疗后3个月和6个月VAS评分则逐渐升高,但射频消融组明显低于药物组(分:3个月为2.00±0.59比3.39±0.70,6个月为2.17±0.51比3.61±0.50,均P<0.05),而且射频消融组术后疼痛疗效优良率和Oswestry功能障碍指数改善优良率均明显高于药物组〔疼痛疗效优良率:94.44%(17/18)比22.22%(4/18),Oswestry功能障碍指数改善优良率:77.78%(14/18)比44.44%(8/18),均P<0.05〕。射频消融组无感染和脊神经前支损伤并发症,药物组有6例出现轻微胃部不适,对症处理后症状缓解。结论腰脊神经后支射频是治疗脊柱术后椎间盘源性腰神经痛的有效治疗方法,比保守药物治疗更能有效地长期缓解疼痛,对功能恢复更好,且操作安全,不良反应很少。Objective To observe the clinical efficacy of radiofrequency ablation for treatment of discogenic lumbar spinal nerve posterior branch neuralgia after vertebral column endoscope operation. Methods Thirtysix patients with discogenic lumbar spinal nerve posterior branch neuralgia after vertebral column endoscope surgery admitted to the Affiliated Hospital of Logistics University of People's Armed Police from December 2011 to December 2017 were enrolled. According to difference in therapeutic methods, they were randomly divided into two groups, 18 cases in each group. The radiofrequency ablation group was treated with X-ray imaging guided lumbar spinal nerve posterior branch radiofrequency thermo-coagulation; the drug group received oral diclofenac sodium conservative treatment, 75 mg twice daily for 3 weeks. Both groups were followed up for 6 months, visual analogue scores (VAS) were used to evaluate the pain before and after treatment, the Oswestry dysfunction index was used to assess the degree of lumbar function recovery, and the surgical complications and adverse drug reactions were observed. Results The VAS scores in the two groups were similar before treatment; after treatment for 1 month, the VAS scores in both groups were significantly lower than those before treatment (radiofrequency ablation group: 1.83±0.71 vs. 5.67±0.77; drug group: 2.22±0.43 vs. 5.28±0.67, both P < 0.05); after treatment for 3 months and 6 months, the VAS scores were increased gradually, however, the scores of radiofrequency ablation group were significantly lower than those in the drug group (3 months was 2.00±0.59 vs. 3.39±0.70, 6 months was 2.17±0.51 vs. 3.61±0.50, both P < 0.05), moreover, the excellent and good rates of postoperative pain efficacy and of Oswestry dysfunction index improvement in the radiofrequency ablation group were significantly higher than those in the drug group [excellent and good rates of postoperative pain efficacy: 94.44% (17/18) vs. 22.22% (4/18), excellent and good rates of Oswestry dysfunction i

关 键 词：腰痛 腰椎间盘 射频 消融 疼痛 

分 类 号：R541.71[医药卫生—心血管疾病]