DSA引导下腰脊神经后支松解治疗老年患者小关节源性腰痛的临床研究
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摘要
目的观察在数字减影血管造影技术(digital subtraction angiography,DSA)引导下腰脊神经后支松解治疗老年患者小关节源性腰痛的疗效及安全性。方法分析2016年7月至2018年7月在武汉市第一医院疼痛科治疗的148例腰椎小关节源性疼痛患者的临床资料。所纳入研究患者随机分为两组,松解组(n=76)和药物组(n=72)。松解组在DSA引导下采用一次性硬膜外穿刺包中硬膜外穿刺针钝性分离腰脊神经后支。药物组患者采用口服消炎镇痛药物治疗。采用视觉模拟评分法(visual analogue scores,VAS)、腰椎功能障碍问卷(Roland-Morris questionnaire,RMQ)及Oswestry功能障碍指数(Oswestry disability index,ODI)评估治疗前及治疗后1、6个月时患者疼痛评分和患者腰椎功能评分。结果本研究首次报道DSA引导下腰脊神经后支松解治疗老年患者小关节源性腰痛。在治疗1个月及6个月时,松解组患者VAS得分明显低于药物组患者,差异有统计学意义[(3.4±1.1)vs.(4.0±1.3),P=0.013;(2.9±1.1)vs.(4.1±1.3),P<0.001]。同样,在治疗1个月及6个月时,松解组患者的RMQ得分、ODI得分明显低于药物组,差异有统计学意义(均P<0.05)。松解组76例患者无麻木及感染等并发症。结论 DSA引导下腰脊神经后支松解治疗可有效缓解老年患者腰椎小关节源性的腰痛症状和改善患者腰部功能状况,且操作安全,无不良反应,值得推广。
Objective To investigate the safety and efficacy of digital subtraction angiography(DSA)-guided neurolysis of posterior ramus of lumbar spinal nerve on old patients with facet-joint-related lumbar pain.Methods A total of 148 patients with chronic low back pain were enrolled in this study from July 2016 to July 2018,in Wuhan No.1 Hospital.All the patients were randomly divided into 2 groups:neurolysis group(n=76)and drug group(n=72).In the neurolysis group,an epidural needle in disposable epidural anaesthesia puncture kit under DSA was used for neurolysis of posterior rami of lumbar spinal nerve.In drug group,patients received the conservative treatment of oral non-steroidal anti-inflammatory drugs(NSAIDs).Visual analogue scores(VAS),Roland-Morris Questionnaire(RMQ)and Oswestry disability Index(ODI)were used to assess pain control and lumbar function before therapy,and at 1 month and 6 months after treatment.Results This was the first report about the DSA-guided neurolysis of posterior ramus of lumbar spinal nerve in old patients with facet-joint-related lumbar pain.VAS in the neurolysis group was significantly lower than that in the drug group at 1 month and 6 months after the treatment[(3.4±1.1)vs.(4.0±1.3),P=0.013;(2.9±1.1)vs.(4.1±1.3),P<0.001].Similarly,RMQ score and ODI score in release group were significantly lower than those in the drug group(all P<0.05).No patients in the neurolysis group had numbness and infection in the innervation area of the treated nerves.Conclusion DSA-guided neurolysis of posterior ramus of lumbar spinal nerve can effectively relieve pain symptoms and improve lumbar function in old patients with facet-joint-related lumbar pain.Additionally,this treatment is safe and has no side effects,thus deserving promoting.
Objective To investigate the safety and efficacy of digital subtraction angiography(DSA)-guided neurolysis of posterior ramus of lumbar spinal nerve on old patients with facet-joint-related lumbar pain.Methods A total of 148 patients with chronic low back pain were enrolled in this study from July 2016 to July 2018,in Wuhan No.1 Hospital.All the patients were randomly divided into 2 groups:neurolysis group(n=76)and drug group(n=72).In the neurolysis group,an epidural needle in disposable epidural anaesthesia puncture kit under DSA was used for neurolysis of posterior rami of lumbar spinal nerve.In drug group,patients received the conservative treatment of oral non-steroidal anti-inflammatory drugs(NSAIDs).Visual analogue scores(VAS),Roland-Morris Questionnaire(RMQ)and Oswestry disability Index(ODI)were used to assess pain control and lumbar function before therapy,and at 1 month and 6 months after treatment.Results This was the first report about the DSA-guided neurolysis of posterior ramus of lumbar spinal nerve in old patients with facet-joint-related lumbar pain.VAS in the neurolysis group was significantly lower than that in the drug group at 1 month and 6 months after the treatment[(3.4±1.1)vs.(4.0±1.3),P=0.013;(2.9±1.1)vs.(4.1±1.3),P<0.001].Similarly,RMQ score and ODI score in release group were significantly lower than those in the drug group(all P<0.05).No patients in the neurolysis group had numbness and infection in the innervation area of the treated nerves.Conclusion DSA-guided neurolysis of posterior ramus of lumbar spinal nerve can effectively relieve pain symptoms and improve lumbar function in old patients with facet-joint-related lumbar pain.Additionally,this treatment is safe and has no side effects,thus deserving promoting.
引文
[1] Patrick N,Emanski E,Knaub M A.Acute and chronic low back pain[J].Med Clin North Am,2014,98(4):777-789.
[2] Freburger J K,Holmes G M,Agans R P,et al.The rising prevalence of chronic low back pain[J].Arch Intern Med,2009,169(3):251-258.
[3] Monticone M,Baiardi P,Vanti C,et al.Responsiveness of the oswestry disability index and the roland morris disability questionnaire in Italian subjects with sub-acute and chronic low back pain[J].Eur Spine J,2012,21(1):122-129.
[4] Manchikanti L,Kaye A D,Boswell M V,et al.A systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain[J].Pain Physician,2015,18(4):E535-E582.
[5] 郑光新,赵晓鸥,刘广林,等.Oswestry功能障碍指数评定腰痛患者的可信性[J].中国脊柱脊髓杂志,2002,12(1):13-15.
[6] Suri P,Miyakoshi A,Hunter D J,et al.Does lumbar spinal degeneration begin with the anterior structures?A study of the observed epidemiology in a community-based population[J].BMC Musculoskelet Disord,2011,12:202.
[7] van Kleef M,Vanelderen P,Cohen S P,et.al.Pain originating from the lumbar facet joints[J].Pain Pract,2010,10(5):459-469.
[8] 王英,曾德敏,谢平,等.脉冲射频联合臭氧注射治疗腰脊神经后支痛的临床疗效研究[J].中国疼痛医学杂志,2017,23(9):699-701.
[9] 张光明,唐坤,陈俊峰.腰椎小关节内注射倍他米松治疗腰椎小关节病变所致慢性腰痛[J].中国临床医学,2011,18(3):299-301.
[10] 廖翔,熊东林,蒋劲,等.对退行性腰椎关节源性腰痛行脊神经后支标准射频手术治疗的随机对照研究[J].中国疼痛医学杂志,2013,19(7):406-410.
[11] 李振宙,侯树勋,商卫林,等.内窥镜下脊神经背内侧支切断术治疗腰椎关节突关节源性慢性腰痛[J].中国脊柱脊髓杂志,2013,23(3):215-221.
[12] Lakemeier S,Lind M,Schultz W,et al.A comparison of intraarticular lumbar facet joint steroid injections and lumbar facet joint radiofrequency denervation in the treatment of low back pain:a randomized,controlled,double-blind trial[J].Anesth Analg,2013,117(1):228-235.
[13] 施栋,单雯.经皮腰脊神经后支射频治疗非特异性腰痛[J].颈腰痛杂志,2009,30(6):555-556.
[14] 黄小冬,段宏伟,张勇军,等.超声引导腰神经后支射频治疗骨质疏松腰痛的临床观察[J].山西医药杂志,2017,46(19):2293-2296.
[15] 杨志洲,朱晓东,李明.脊神经后支综合征的诊治[J].脊柱外科杂志,2008,6(5):308-310.
[16] Cansever T.Comparison of effectiveness of facet joint injection and radiofrequency denervation in chronic low back pain[J].Turk Neurosurg,2012,22(2):200-206.
[2] Freburger J K,Holmes G M,Agans R P,et al.The rising prevalence of chronic low back pain[J].Arch Intern Med,2009,169(3):251-258.
[3] Monticone M,Baiardi P,Vanti C,et al.Responsiveness of the oswestry disability index and the roland morris disability questionnaire in Italian subjects with sub-acute and chronic low back pain[J].Eur Spine J,2012,21(1):122-129.
[4] Manchikanti L,Kaye A D,Boswell M V,et al.A systematic review and best evidence synthesis of the effectiveness of therapeutic facet joint interventions in managing chronic spinal pain[J].Pain Physician,2015,18(4):E535-E582.
[5] 郑光新,赵晓鸥,刘广林,等.Oswestry功能障碍指数评定腰痛患者的可信性[J].中国脊柱脊髓杂志,2002,12(1):13-15.
[6] Suri P,Miyakoshi A,Hunter D J,et al.Does lumbar spinal degeneration begin with the anterior structures?A study of the observed epidemiology in a community-based population[J].BMC Musculoskelet Disord,2011,12:202.
[7] van Kleef M,Vanelderen P,Cohen S P,et.al.Pain originating from the lumbar facet joints[J].Pain Pract,2010,10(5):459-469.
[8] 王英,曾德敏,谢平,等.脉冲射频联合臭氧注射治疗腰脊神经后支痛的临床疗效研究[J].中国疼痛医学杂志,2017,23(9):699-701.
[9] 张光明,唐坤,陈俊峰.腰椎小关节内注射倍他米松治疗腰椎小关节病变所致慢性腰痛[J].中国临床医学,2011,18(3):299-301.
[10] 廖翔,熊东林,蒋劲,等.对退行性腰椎关节源性腰痛行脊神经后支标准射频手术治疗的随机对照研究[J].中国疼痛医学杂志,2013,19(7):406-410.
[11] 李振宙,侯树勋,商卫林,等.内窥镜下脊神经背内侧支切断术治疗腰椎关节突关节源性慢性腰痛[J].中国脊柱脊髓杂志,2013,23(3):215-221.
[12] Lakemeier S,Lind M,Schultz W,et al.A comparison of intraarticular lumbar facet joint steroid injections and lumbar facet joint radiofrequency denervation in the treatment of low back pain:a randomized,controlled,double-blind trial[J].Anesth Analg,2013,117(1):228-235.
[13] 施栋,单雯.经皮腰脊神经后支射频治疗非特异性腰痛[J].颈腰痛杂志,2009,30(6):555-556.
[14] 黄小冬,段宏伟,张勇军,等.超声引导腰神经后支射频治疗骨质疏松腰痛的临床观察[J].山西医药杂志,2017,46(19):2293-2296.
[15] 杨志洲,朱晓东,李明.脊神经后支综合征的诊治[J].脊柱外科杂志,2008,6(5):308-310.
[16] Cansever T.Comparison of effectiveness of facet joint injection and radiofrequency denervation in chronic low back pain[J].Turk Neurosurg,2012,22(2):200-206.