CT引导下针刺手法操作脉冲射频联合神经根阻滞治疗腰骶神经根痛106例回顾性分析  

CT-guided Pulsed Radiofrequency under Acupuncture Manipulation Techniques Combined with Nerve Root Block for Lumbosacral Radicular Pain:A Retrospective Analysis of 106 Cases

作　　者：孙佩宇[1] 雷仲民[1] 李春根 彭亚[1] 尹辛成[1] 张凤全[1] SUN Peiyu;LEI Zhongmin;LI Chungen;PENG Ya;YIN Xincheng;ZHANG Fengquan(Beijing Hospital of Traditional Chinese Medicine,Capital Medical University,Beijing,100010)

机构地区：[1]首都医科大学附属北京中医医院,北京100010

出　　处：《中医杂志》2021年第14期1238-1242,共5页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81473771)。

摘　　要：目的评价CT引导下针刺手法操作脉冲射频联合神经根阻滞治疗腰骶神经根痛的有效性和安全性。方法运用回顾性分析方法收集106例腰骶神经根痛患者临床资料,所有患者先行CT检查确定责任神经根背根神经节的位置,并选定穿刺进针点。在CT引导下将射频套管应用毫针夹持进针法,进皮后向背根神经节方向缓慢推进。当套管推进至距背根神经5mm以内时采用毫针捻转手法小幅缓慢地往复捻转进针(每秒往复1次,幅度10°),直至套管尖端到达背根神经节背侧1mm处,再行脉冲射频联合神经根阻滞治疗。比较术前、术后即刻及术后1周、1个月、3个月、6个月时下肢疼痛视觉模拟评分(VAS评分),术前及术后1周、1个月、3个月、6个月时Oswestry功能障碍指数(ODI)评分,并在下肢疼痛最明显处采用软组织张力仪分析施加0.2kg载荷时局部软组织的位移大小(FDD值)及局部软组织所吸收能量占所做功的百分比(S值),并记录不良事件发生情况。结果与术前比较,术后即刻及术后1周、1个月、3个月和6个月时VAS评分明显降低,FDD值及S值均明显升高(P<0.05);术后1周、1个月、3个月和6个月时ODI评分明显降低(P<0.05)。所有患者术中及术后6个月内均无神经根损伤、硬膜损伤、腰背痛加重及感染等不良事件发生。结论CT引导下针刺手法操作脉冲射频联合神经根阻滞治疗腰骶神经根痛可有效减轻患者下肢疼痛、改善活动功能,并降低软组织张力,且安全性好。Objective To evaluate the effectiveness and safety of CT-guided pulsed radiofrequency(PR)under acupuncture manipulation techniques combined with nerve root block(NRB)for lumbosacral radicular pain(LRP).Methods Clinical data of 106 LRP patients were retrospectively collected.All the patients underwent CT examination to check the position of the dorsal root ganglion of the responsible nerve root and to determine the puncture point.The radiofrequency cannula was inserted to the skin with hand-grasping insertion method,and was guided by CT to the dorsal root ganglion.When the cannula was approached within 5 mm of dorsal root ganglion,slight and slow twirling method was used(one twirling each second,insertion angle of 10°)till the tip of cannula reached 1 mm within the back of the dorsal root ganglion;from then on,PR combined with NRB were carried out.The lower limbs pain visual analogue scale(VAS)score and Oswestry dysfunction index(ODI)score were assessed before operation,immediately after operation and 1 week,1,3 and 6 months after operation;for the most painful part of the lower limbs,soft tissue tension meter was used to analyze the force displacement distance(FDD)and uptake percentage of energy accounted for measuring work(S)of local soft tissues when a 0.2 kg load was applied;adverse events were recorded.Results The VAS scores were significantly reduced while FDD values and S values increased immediately after operation and 1 week,1,3 and 6 months after operation compared to those before operation(P<0.05);ODI scores decreased significantly at 1 week,1,3 and 6 months after operation(P<0.05).No patients had adverse events such as nerve root injury,dural injury,worsening of low back pain and infection during intraoperative period and within 6 months after the operation.Conclusion CT-guided PR under acupuncture manipulation techniques combined with NRB can effectively reduce lower limb pain,improve mobility,reduce soft tissue tension,and is considered to be safe when treating LRP.

关 键 词：腰骶神经根痛 针刺手法 脉冲射频 神经根阻滞 疼痛 软组织张力 

分 类 号：R246.9[医药卫生—针灸推拿学]