射频热凝与亚甲蓝注射治疗盘源性腰痛的疗效比较  

Efficacy Comparison of Radiofrequency Thermocoagulation and Methylene Blue Injection for Treatment of Discogenic Low Back Pain

作　　者：王翔奕[1] 刘世伟[1] 张进 文超 Wang Xiangyi;Liu Shiwei;Zhang Jin;Wen Chao(Department of Rehabilitation and Pain,Zigong Fourth People’s Hospital,Zigong 643000,China)

机构地区：[1]自贡市第四人民医院康复疼痛科,四川自贡643000

出　　处：《实用骨科杂志》2022年第4期313-316,共4页Journal of Practical Orthopaedics

摘　　要：目的比较射频热凝与亚甲蓝注射治疗椎间盘造影纤维环完全破裂造影剂漏至盘外类型的盘源性腰痛的近期疗效。方法2020年4月至2021年4月,自贡市第四人民医院收治的72例临床诊断为盘源性腰痛,且椎间盘造影阳性患者,其中40例纤维环完全破裂造影剂漏至盘外,按入院顺序单双号随机将患者分为两组。A组20例行射频热凝治疗,男15例,女5例;年龄23~58岁,平均(47.41±11.46)岁。B组20例行亚甲蓝注射治疗,男14例,女6例;年龄29~65岁,平均(48.23±7.70)岁。治疗前后采用疼痛视觉模拟评分(visual analogue scale,VAS)和日本骨科协会评分(Japanese orthopaedic association,JOA)进行评价。结果所有患者均获随访,随访时间8~14个月,平均随访(12.00±1.65)个月。组内VAS与JOA评分术前、术后末次随访比较,差异有统计学意义(P<0.05)。组间VAS与JOA评分术前比较,差异无统计学意义(P>0.05);术后末次随访比较,差异有统计学意义(P<0.05)。A组治疗改善率平均(81.65±13.37)%,优良率94.45%;B组平均(30.67±16.79)%,优良率16.78%,组间比较差异有统计学意义(P<0.05)。所有患者均未发生重要血管神经损伤、感染等并发症。结论对于椎间盘造影纤维环完全破裂造影剂漏至盘外类型的盘源性腰痛,射频热凝的疗效优于亚甲蓝注射,建议此类型的盘源性腰痛采用射频热凝治疗。Objective To compare the short-term efficacy of radiofrequency thermocoagulation and methylene blue injection in the treatment of discogenic low back pain with complete rupture of intervertebral disc contrast annulus and leakage of contrast medium outside the disc.Methods From April 2020 to April 2021,72 patients with discogenic low back pain and positive discography were treated in Zigong Fourth People’s Hospital, including 40 patients with complete rupture of fibrous ring and leakage of contrast medium outside the disc.The patients were randomly divided into two groups according to the order of admission.In group A,20 patients were treated with radiofrequency thermocoagulation, including 15 males and 5 females.The age ranged from 23 to 58 years, with an average of(47.41±11.46)years.Group B was treated with methylene blue injection, including 14 males and 6 females, aged from 29 to 65 years, with an average of(48.23±7.70)years.Visual analogue scale(VAS) and Japanese Orthopedic Association(JOA) were used to evaluate the pain before and after treatment.Results All patients were followed up for 8 to 14 months, with an average of(12.00±1.65)months.VAS and JOA scores in the group were significantly different in preoperative and postoperative follow-up(P<0.05).There was no statistically significant difference in VAS and JOA scores between the groups before surgery(P>0.05),and there was a statistically significant difference in the last follow-up after surgery(P<0.05).The treatment improvement rate in group A was(81.65±13.37)%,and the excellent rate was 94.45%.In group B,the average was(30.67±16.79)%,the excellent rate was 16.78%.The difference between groups was statistically significant(P<0.05).All patients had no serious vascular nerve injury, infection and other complications.Conclusion Radiofrequency thermocoagulation is more effective than methylene blue injection for discogenic low back pain with complete rupture of discography annulus and leakage of contrast medium outside the disc.Radiofrequency thermoc

关 键 词：椎间盘 射频 亚甲蓝 

分 类 号：R681.55[医药卫生—骨科学]