经皮脊神经后内侧支毁损术治疗慢性关节突关节源性腰痛
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摘要
目的:观察经皮脊神经后内侧支毁损术治疗慢性关节突关节源性腰痛的临床疗效,探讨其应用的安全性及有效性。方法:2015年8月至2017年5月,收治慢性腰痛病人76例,所有病人均经对照性诊断阻滞确诊为关节突关节源性腰痛。根据病人选择及知情同意,42例经皮脊神经后内侧支毁损术治疗(射频组),34例采用保守治疗(对照组)。病人评价治疗前后视觉模拟评分(visual analogue scale, VAS)、腰椎Oswestry功能障碍指数(oswestry disability index, ODI)及病人满意度(patient Satisfaction Index, PSI),并行腰椎动力位X线检查,观察腰椎活动度(range of motion, ROM)的变化情况。所有病人接受6～30个月的随访。结果:治疗后4周、12周及末次随访时,对照组VAS评分、ODI指数和腰椎整体ROM与治疗后2周有显著差异(P <0.05)。治疗2周后各时间点,射频组VAS评分、ODI指数明显低于对照组,腰椎整体ROM则明显高于对照组,各指标均明显优于治疗前(P <0.05),与治疗后2周无显著差异。结论:经皮脊神经后内侧支毁损术是治疗慢性关节突关节源性腰痛安全、有效的方法,疗效优于传统保守治疗方法。
Objective: To investigate the early clinical and radiological outcome and evaluate the safety and efficiency of percutaneous ablation of dorsal ramus branches to treat chronic lumbar zygapophyseal joint originated pain. Methods: From August 2015 to May 2017, 76 patients with chronic low back pain were diagnosed as chronic lumbar zygapophyseal joint originated pain after controlled differential(double) medial branch block(MBB). According to the patient' s choice and informed consent, 42 cases underwent percutaneous ablation of medial branch of posterior lumbar ramus(group A), while 34 cases underwent conservative treatment, including NSAIDs, physical therapy and recognition therapy(group B). The clinical evaluation included visual analogue scale(VAS), Oswestry disability index(ODI), and patient satisfaction index(PSI) at pre-operation and final follow-up. Radiographic evaluation included range of lumbar motion(ROM) in the flexion/extension lateral view. All cases were followed up 15.6 months on average(6-30 months). Results: The VAS score, ODI score and lumbar ROM were significantly improved in group B at 4 and 12 weeks and final follow-up compared with those at 2 weeks after treatment(P < 0.05) and were similar with before treatment(P > 0.05). The VAS score, ODI score and lumbar ROM at each time point of post-treatment 2 weeks were significantly improved in group A compared with those in group B(P < 0.05) and had no significant difference with those at 2 weeks after treatment(P > 0.05). Conclusion: This study shows that percutaneous ablation of medial branch of posterior lumbar ramus is a more effective procedure than conservative treatment for the treatment of chronic lumbar zygapophyseal joint originated pain
Objective: To investigate the early clinical and radiological outcome and evaluate the safety and efficiency of percutaneous ablation of dorsal ramus branches to treat chronic lumbar zygapophyseal joint originated pain. Methods: From August 2015 to May 2017, 76 patients with chronic low back pain were diagnosed as chronic lumbar zygapophyseal joint originated pain after controlled differential(double) medial branch block(MBB). According to the patient' s choice and informed consent, 42 cases underwent percutaneous ablation of medial branch of posterior lumbar ramus(group A), while 34 cases underwent conservative treatment, including NSAIDs, physical therapy and recognition therapy(group B). The clinical evaluation included visual analogue scale(VAS), Oswestry disability index(ODI), and patient satisfaction index(PSI) at pre-operation and final follow-up. Radiographic evaluation included range of lumbar motion(ROM) in the flexion/extension lateral view. All cases were followed up 15.6 months on average(6-30 months). Results: The VAS score, ODI score and lumbar ROM were significantly improved in group B at 4 and 12 weeks and final follow-up compared with those at 2 weeks after treatment(P < 0.05) and were similar with before treatment(P > 0.05). The VAS score, ODI score and lumbar ROM at each time point of post-treatment 2 weeks were significantly improved in group A compared with those in group B(P < 0.05) and had no significant difference with those at 2 weeks after treatment(P > 0.05). Conclusion: This study shows that percutaneous ablation of medial branch of posterior lumbar ramus is a more effective procedure than conservative treatment for the treatment of chronic lumbar zygapophyseal joint originated pain
引文
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[13]Raj PP. Intervertebral disc:anatomy-physiology-pathophysiology-treatment[J]. Pain practice, 2008, 8:18-44.
[14]KallakuriS,Singh A,ChenC, etal.Demonstration ofsubstanceP,calcitoningene-relatedpeptide,and proteingeneproduct9.5containingnervefibersin humancervicalfacetjointcapsules[J].Spine,2004,29:1182-1186.
[15]AhmedM,Bjurholm A,Kreicbergs A, etal.Sensory and autonomic innervation of the facet joint in the rat lumbar spine[J]. Spine, 1993, 18:2121-2126.
[16]Cavanaugh JM, Lu Y, Chen C, et al. Pain generation in lumbar and cervical facet joints[J]. J Bone Joint Surg Am, 2006, 88 Suppl 2:63-67.
[17]Zhenbo Z, Huanting L, Jin W, et al. Hemilaminoplasty forthetreatmentoflumbarintraspinalsynovialcysts(LISCs)andliteraturereview[J].EurSpineJ,2016,25:3393-3402.
[18]Wolter T, Bozhkov Y, Knoeller SM. An in vitro analysis of the size and shape of cryolesions for facet joint denervation[J]. Clin Neurol Neurosurg, 2017, 153:87-92.
[19]Kallakuri S, Singh A, Lu Y, et al. Tensile stretching of cervicalfacetjointcapsuleandrelatedaxonalchanges[J]. Eur Spine J, 2008, 17:556-563.
[20]Laplante BL, Ketchum JM, Saullo TR, et al. Multivariable analysis of the relationship between pain referral patternsandthesourceofchroniclowbackpain[J].Pain physician, 2012, 15:171-178.
[21]Mooney V,RobertsonJ. Thefacetsyndrome[J].Clin Orthop Relat Res, 1976, 115:149-156.
[22]Bogduk N. Evidence-informed management of chronic low back pain with facet injections and radiofrequency neurotomy[J]. Spine J, 2008, 8:56-64.
[23]李振宙,商卫林,宋科冉,等.内窥镜下脊神经背内侧支切断术治疗慢性关节突关节源性腰痛的临床运用及疗效分析[J].中国疼痛医学杂志, 2013, 19(10):580-586.
[24]LeggettLE,SorilLJ,LorenzettiDL, etal.Radiofrequency ablation for chronic low back pain:a systematic reviewofrandomizedcontrolledtrials[J].PainRes Manag, 2014, 19:e146-153.
[25]Arsanious D, Gage E, Koning J, et al. Pulsed Dose Radiofrequency Before Ablation of Medial Branch of the LumbarDorsalRamusforZygapophysealJointPain Reduces Post-procedural Pain[J]. Pain Physician, 2016,19:477-484.
[2]Putti V.Newconceptsinthepathogenesisofsciatica pain[J]. Lancet, 1927, 2:53-60.
[3]Ghormley RK. Low back pain with special reference to the articular facets, with presentationof an operative procedure[J]. JAMA, 1933, 101:1773-1777.
[4]Juch JNS, Maas ET, Ostelo RWJG, et al. Effect of RadiofrequencyDenervationonPainIntensity Among Patients With Chronic Low Back Pain:The Mint Randomized Clinical Trials[J]. JAMA, 2017, 318:68-81.
[5]LeeCH,ChungCK,KimCH. Theefficacyofconventionalradiofrequencydenervationinpatientswith chronic low back pain originating from the facet joints:ameta-analysisofrandomizedcontrolledtrials[J].Spine J, 2017, 17:1770-1780.
[6]BoswellMV,Singh V,StaatsPS, etal. Accuracyof precision diagnostic blocks in the diagnosis of chronic spinalpainoffacetorzygapophysialjointorigin[J].Pain physician, 2003, 6:449-456.
[7]李忠海,侯树勋.小关节源性腰痛机制研究进展[J].中国脊柱脊髓杂志, 2013, 23:943-946.
[8]HanSH,ParkKD,ChoKR, etal.Ultrasoundversus fluoroscopy-guided medial branch block for the treatment of lower lumbar facet joint pain:A retrospective comparativestudy[J].Medicine(Baltimore),2017,96:e6655.
[9]李振宙,侯树勋,商卫林,等.内窥镜下腰脊神经背内侧支解剖变异及其临床意义[J].中国骨与关节杂志, 2013, 2(4):188-193.
[10]BogdukN.Diagnosinglumbarzygapophysialjoint pain[J]. Pain Med, 2005, 6:139-142.
[11]Fairbank JC, Pynsent PB. The Oswestry Disability Index[J]. Spine, 2000, 25:2940-2953.
[12]RobertsonJT,PapadopoulosSM, Traynelis VC. Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty:a prospective 2-year study[J]. J Neurosurg Spine, 2005, 3:417-423.
[13]Raj PP. Intervertebral disc:anatomy-physiology-pathophysiology-treatment[J]. Pain practice, 2008, 8:18-44.
[14]KallakuriS,Singh A,ChenC, etal.Demonstration ofsubstanceP,calcitoningene-relatedpeptide,and proteingeneproduct9.5containingnervefibersin humancervicalfacetjointcapsules[J].Spine,2004,29:1182-1186.
[15]AhmedM,Bjurholm A,Kreicbergs A, etal.Sensory and autonomic innervation of the facet joint in the rat lumbar spine[J]. Spine, 1993, 18:2121-2126.
[16]Cavanaugh JM, Lu Y, Chen C, et al. Pain generation in lumbar and cervical facet joints[J]. J Bone Joint Surg Am, 2006, 88 Suppl 2:63-67.
[17]Zhenbo Z, Huanting L, Jin W, et al. Hemilaminoplasty forthetreatmentoflumbarintraspinalsynovialcysts(LISCs)andliteraturereview[J].EurSpineJ,2016,25:3393-3402.
[18]Wolter T, Bozhkov Y, Knoeller SM. An in vitro analysis of the size and shape of cryolesions for facet joint denervation[J]. Clin Neurol Neurosurg, 2017, 153:87-92.
[19]Kallakuri S, Singh A, Lu Y, et al. Tensile stretching of cervicalfacetjointcapsuleandrelatedaxonalchanges[J]. Eur Spine J, 2008, 17:556-563.
[20]Laplante BL, Ketchum JM, Saullo TR, et al. Multivariable analysis of the relationship between pain referral patternsandthesourceofchroniclowbackpain[J].Pain physician, 2012, 15:171-178.
[21]Mooney V,RobertsonJ. Thefacetsyndrome[J].Clin Orthop Relat Res, 1976, 115:149-156.
[22]Bogduk N. Evidence-informed management of chronic low back pain with facet injections and radiofrequency neurotomy[J]. Spine J, 2008, 8:56-64.
[23]李振宙,商卫林,宋科冉,等.内窥镜下脊神经背内侧支切断术治疗慢性关节突关节源性腰痛的临床运用及疗效分析[J].中国疼痛医学杂志, 2013, 19(10):580-586.
[24]LeggettLE,SorilLJ,LorenzettiDL, etal.Radiofrequency ablation for chronic low back pain:a systematic reviewofrandomizedcontrolledtrials[J].PainRes Manag, 2014, 19:e146-153.
[25]Arsanious D, Gage E, Koning J, et al. Pulsed Dose Radiofrequency Before Ablation of Medial Branch of the LumbarDorsalRamusforZygapophysealJointPain Reduces Post-procedural Pain[J]. Pain Physician, 2016,19:477-484.