B超引导和X线引导下脊神经后内侧支射频消融术治疗腰椎小关节源性疼痛的疗效比较  

Ultrasound-guided versus X-ray-guided radiofrequency neurotomy on posterior medial branch for treatment of lumbar facet joint-related back pain

作　　者：杨兆 李斌本[2] YANG Zhao;LI Binben(Department of Radiology,Navy Medical University(Second Military Medical University),Shanghai 200433,China;Department of Anesthesiology Changhai Hospital,Navy Medical University(Second Military Medical University),Shanghai 200433,China)

机构地区：[1]海军军医大学(第二军医大学)长海医院影像医学科,上海200433 [2]海军军医大学(第二军医大学)长海医院麻醉科,上海200433

出　　处：《解放军医学院学报》2019年第9期864-868,共5页Academic Journal of Chinese PLA Medical School

摘　　要：目的比较B超引导和X线引导下脊神经后内侧支射频消融术治疗腰椎小关节源性疼痛的疗效及安全性。方法选取2016年1月-2018年1月上海长海医院就诊的腰椎小关节源性疼痛患者90例,随机分为两组,各45例。其中B超引导组采用B超引导下脊神经后内侧支射频消融术,X线引导组采用X线引导下脊神经后内侧支射频消融术。采用视觉模拟评分(visual analog scale,VAS)对治疗前和治疗后各时间点的疼痛及疗效进行评估,VAS降低≥50%视为有效,同时采用Oswestry功能障碍指数(Oswestry disability index,ODI)进行治疗前后的功能评估。结果治疗前两组VAS评分和ODI评分均无显著差别,治疗后1周、3个月、6个月和12个月,两组患者VAS评分和ODI评分较各自术前均显著降低,但组间比较无显著差异;治疗后3个月,B超引导组和X线引导组临床有效率分别为86.7%和82.2%,至术后12个月,两组有效率仍维持在50%以上。相比X线引导组,B超引导组手术时间更短(22.2±3.5 min vs 32.4±6.9 min,P<0.01);两组术中、术后均未发生不良反应。结论B超引导下行脊神经后内侧支射频消融术治疗腰椎小关节源性疼痛,疗效显著且持久,与X线相比疗效相当。超声具有快速、无损、无辐射、安全等优点,值得临床推广。Objective To compare the effectiveness and safety of ultrasound-guided versus X-ray-guided radiofrequency neurotomy on posterior medial branch for treatment of lumbar facet joint-related back pain.Methods A total of 90 patients with lumbar facet joint-related back pain treated in the Shanghai Changhai Hospital from January 2016 to January 2018 were enrolled into this study.The patients were randomly assigned into two groups,with 45 patients in each group.Patients in ultrasound-guided group were treated with radiofrequency neurotomy on posterior medial branch under the guidance of ultrasound,while patients in X-ray group were treated under the guidance of X-ray.The visual analog scale(VAS)was used to evaluate pain and curative effect before and after treatment.We rated efficacy as effective when post-treatment VAS score decreased by 50%or more.The Oswestry disability index(ODI)was used to evaluate the function before and after treatment.Results There was no significant difference in VAS scores between the two groups before treatment.The VAS scores and ODI index significantly reduced in both groups at 1 week,3 months,6 months,and 12 months after treatment compared to pre-treatment,while no significant difference was found between these two groups.At 3 months after treatment,86.7%patients in the ultrasound-guided group and 82.2%patients in the X-ray-guided group achieved good outcome(P>0.05).At 12 months after treatment,both the two treatments were still effective in more than 50%patients.As compared to X-ray-guided group,the operating time in the ultrasound-guided group was much shorter(22.2±3.5 min vs32.4±6.9 min,P<0.01).No complication was found in both groups.Conclusion The ultrasound-guided radiofrequency neurotomy on posterior medial branch is effective and safe for treatment of lumbar facet joint-related back pain,and its efficacy is equal to the X-ray-guided radiofrequency,which is worthy of clinical application.

关 键 词：腰痛 腰椎 小关节 B超 射频消融 X线 

分 类 号：R681.55[医药卫生—骨科学]