摘要
[目的]观察经皮脊神经背内侧支毁损术治疗腰椎术后慢性腰痛的临床疗效。[方法] 2015年8月～2017年5月,收治腰椎术后慢性腰痛患者43例,所有患者均经对照性诊断封闭确诊。根据患者选择及知情同意,20例行经皮脊神经背内侧支毁损术治疗(射频消融组),23例采用神经阻滞术治疗(神经阻滞组)。所有患者治疗前后随访时应用视觉模拟评分(VAS评分)、腰椎Oswestry功能障碍指数(ODI指数)及患者满意度(PSI)评价治疗效果,并行腰椎动力位X线片检查,测量腰椎活动度(ROM)。[结果]所有患者获得6～32个月的随访。治疗后1周,两组VAS评分、ODI指数及腰椎整体ROM明显优于治疗前(P<0.05),但两组间在2个时间点的差异均无统计学意义(P>0.05)。此后,射频消融组各指标随时间延长持续改善,而神经阻滞组各指标显著恶化,治疗后1、3个月及末次随访时射频消融组上述指标显著优于神经阻滞组,差异均有统计学意义(P<0.05)。末次随访时,射频消融组的患者满意度[(1.75±0.77) vs(2.70±0.86),P<0.05]和治疗有效率(90.00%vs 39.13%,P<0.05)显著优于神经阻滞组。[结论]经皮脊神经背内侧支毁损术是治疗腰椎术后慢性腰痛安全、有效的方法,疗效优于传统局部神经阻滞方法。
[Objective] To explore the clinical outcomes of percutaneous radiofrequency ablation of medial branch of posterior lumbar ramus for chronic low back pain secondary to failed back surgery syndrome.[Methods] Between August 2015 and May 2017,43 patients with chronic low back pain were diagnosed of chronic lumbar zygapophyseal joint originated pain by controlled differential medial branch block(MBB).According to the patient’s choice after informed consent,20 patients underwent percutaneous radiofrequency ablation of medial branch of posterior lumbar ramus(the PRA group),while 23 cases underwent nerve block therapy(the NB group).The clinical evaluation was conducted by using visual analogue scale(VAS) for pain,Oswestry disability index(NDI),and patient satisfaction index(PSI),as well as lumbar range of motion(ROM) measured on dynamic lateral radiographs.[Results] All patients were followed up for 6-32 months.In both groups,The VAS and ODI at 1 week after treatment significantly decreased,whereas lumbar ROM significantly increased compared with those before treatment(P<0.05),which had no significant difference between the two groups at both time points(P>0.05).After that,the VAS score,ODI score and lumbar ROM continued to improve in the PRA group,whereas deteriorated in the NB group as time went.The PRA group was significantly superior to the NB group in aforesaid parameters at 1 month,3 months and the latest follow-up with statistical significances(P<0.05).At the latest follow up,the PRA group significantly surpassed the NB group regarding to PSI[(1.75±0.77) vs 2.70±0.86),P<0.05] and therapy efficiency(90.00% vs 39.13%,P<0.05).[Conclusion] Percutaneous radiofrequency ablation of medial branch of posterior lumbar ramus is an effective procedure for the treatment of chronic low back pain resulting from failed back surgery syndrome,which is superior to conservative treatment.
作者
李忠海
刘谟震
诸进
徐晓鑫
李振宙
侯树勋
LI Zhong-hai;LIU Mo-zhen;CHU Jin;XU Xiao-xin;LI Zhen-zhou;HOU Shu-xun(Department of Orthopaedics,The First Affiliated Hospital,Dalian Medical University,Dalian,116600,China;Department of Orthopaedics,The First Affiliated Hospital of PLA General Hospital,Belting 100048,China)
出处
《中国矫形外科杂志》
CAS
CSCD
北大核心
2019年第3期204-209,共6页
Orthopedic Journal of China
基金
辽宁省自然科学基金指导计划项目(编号:20170540294)
辽宁省高等学校基本科研项目(编号:LQ2017022)
关键词
腰椎术后综合征
慢性腰痛
脊神经背内侧支
经皮射频消融术
failed back surgery syndrome
chronic low back pain
medial branch of posterior lumbar ramus
percutaneous radiofrequency ablation
