摘要
目的探讨CT引导下背根神经节(DRG)行连续射频(CRF)和脉冲射频(PRF)对胸背部带状疱疹后神经痛(PHN)患者的疗效和安全性。方法收集2013年1月至2018年12月天津医科大学第二医院疼痛治疗中心确诊的胸背部PHN患者116例,将其分为倍他米松组(B组,n=37)、连续射频热凝组(CRF组,n=39)、脉冲射频调控组(PRF组,n=40)。根据疼痛范围及脊神经节段性分布确定神经痛受累节段,3组均在CT引导下经皮椎间孔内穿刺,B组给予复方倍他米松,CRF组和PRF组分别对DRG行连续射频和脉冲射频各360 s,同时注射复方倍他米松。于治疗前和治疗后1、7 d及1、3个月时进行视觉模拟评分(VAS),治疗后3个月时评价优良率和有效率,以及观察并发症情况。结果与治疗前比较,B组治疗后1和7 d时VAS降低、CRF组和PRF组治疗后1、7 d及1、3个月时VAS降低;与B组比较,CRF组和PRF组治疗后1、7 d及1、3个月时VAS降低(P均<0.05)。B组、CRF组和PRF组治疗后3个月有效率分别为51%(19/37例)、85%(33/39例)和83%(33/40例),优良率分别为22%(8/37例)、72%(28/39例)和63%(25/40例)。CRF组中13例出现神经支配区感觉减退,5例出现痛性麻木,1例出现神经损伤伴同侧下肢感觉和运动障碍;PRF组6例出现神经支配区感觉稍减退,B组5例出现神经支配区感觉稍减退。结论CT引导下经皮穿刺椎间孔内近DRG行CRF和PRF复合复方倍他米松给药治疗胸背部PHN疗效均优于单纯复方倍他米松给药,PRF术后并发症发生率低于CRF,安全性较高。
Objective To evaluate the efficacy and safety of continuous or pulsed radiofrequency on dorsal root ganglia for the treatment of postherpetic neuralgia in chest and back under the guidance of CT.Methods One hundred and sixteen patients with postherpetic neuralgia in thoracic back region in the Department of Pain Management of Second Hospital of Tianjin Medical University from January 2013 to December 2018 were divided to betamethasone group(group B,n=37),continuous radiofrequency group(group CRF,n=39)and pulsed radiofrequency group(group PRF,n=40).Patients were treated by injection of compound betamethasone into intervertebral foramina in group B,continuous radiofrequency at 70°C combined with compound betamethasone in group CRF and pulsed radiofrequency combined with compound betamethasone in group PRF.Visual analogue scale(VAS)was evaluated before the treatment and at the 1 day,7 days,1 month and 3 months after the treatment.The rates of complete relief,excellent effect and good effect were calculated and postoperative complications were recorded at 3 months after the treatment.Results Compared with pre-treatment,VAS was significantly decreased at 1 day and 7 days after the treatment in group B and 1 day,7 days,1 month and 3 months after the treatment in group CRF and PRF(P<0.05).Compared with group B,VAS was significantly lower at 1 day,7days,1 month and 3 months after the treatment in group CRF and PRF(all P<0.05).The overall effective rate at 3 months after the treatment was 51%(19/37 cases),85%(33/39 cases)and 83%(33/40 cases)in group B,group CRF and group PRF respectively.The rate of excellent effect was 22%(8/37 cases),72%(28/39 cases)and 63%(25/40 cases)respectively.Hypoesthesia appeared in 13 patients and anesthesia dolorosa appeared in 5 patients in group CRF respectively.Furthermore 1 patient got nerve injury followed with dyskinesia in homolateral lower limb in group CRF.Six patients and Five patients got slightly hypoesthesia in group PRF and group B respectively.Conclusion The efficacy of CRF and PRF on DRG combined with compound betamethasone injection under the guidance of CT is better for the treatment of PHN in chest and back than that of compound betamethasone injection only.PRF was safer with fewer complications.
作者
刘靖芷
史可梅
马文庭
李全波
付强
郑宝森
Liu Jingzhi;Shi Kemei;Ma Wenting;Li Quanbo;Fu Qiang;Zheng Baosen(Department of Pain Management,Second Hospital of Tianjin Medical University,Tianjin 300211,China)
出处
《中华疼痛学杂志》
2020年第3期204-208,共5页
Chinese Journal Of Painology
基金
天津医科大学科学基金(2004ky43)
天津医科大学第二医院科研基金(Y1205)。
