脊神经背内侧支切断术治疗腰椎术后慢性腰痛
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摘要
[目的]探讨内窥镜下脊神经背内侧支切断术治疗腰椎术后慢性腰痛的临床效果。[方法]选取2015年8月～2017年12月本院骨科收治的74例腰椎术后慢性腰痛患者为研究对象,采用随机数字法分为两组。其中,37例切断组行内窥镜下脊神经背内侧支切断术治疗;37例行局部封闭保守治疗。比较患者术前、术后改良日本骨科学会评分(JOA)、腰椎视觉模拟评分(VAS)和腰椎改良MacNab功能评分。[结果]所有患者均顺利完成治疗;与术前相比,切断组与封闭组术后1个月VAS评分显著降低,而JOA评分显著增加,差异均有统计学意义(P<0.05)。切断组术后VAS评分随时间延长继续减少,JOA评分继续增加,不同时间点差异无统计计学意义(P>0.05),而封闭组术后VAS随时间延长再次增加,JOA评分再次减少,但不同时间点差异无统计学意义(P>0.05)。术后各时间点切断组的VAS和JOA评分均优于封闭组,差异均有统计学意义(P<0.05)。术后1年,切断组腰椎改良MacNab功能评分优良率(94.59%)高于封闭组(45.95%),差异具有统计学意义(P<0.05)。[结论]内窥镜下脊神经背内侧支切断术对治疗腰椎术后慢性腰痛具有良好的临床效果。
[Objective] To explore the clinical outcomes of endoscopic neurectomy of dorsal medial branch of spine nerve for chronic low back pain secondary to lumbar spine surgery. [Methods] From August 2015 to December 2017, 74 patients with chronic low back pain after lumbar spine surgery in our hospital were selected as the subjects who were divided into two groups by random number method in this study. Of the patients, 37 patients underwent endoscopic neurectomy of dorsal medial branch of spine nerve by radiofrequency ablation(the cutting off group), while the remaining 37 patients received the nerve block(the block group). The visual analogue scale(VAS) for pain, the Japanese Orthopedic Society(JOA) score and modified MacNab criteria were compared before and after treatment. [Results] All patients had the treatment conducted successfully. Compared with those preoperatively, the VAS significantly decreased, whereas the JOA scores significantly increased at 1 month after operation in both group(P<0.05). After that, in the cutting off group the VAS continued to decline, while JOA score continued to elevate over time, with no significant difference among time points postoperatively(P>0.05). By contrast, in the lock group the VAS increased again, whereas the JOA score decreased once more with no significant difference among time points postoperatively(P>0.05). In addition, the cutting off group with lower VAS and higher JOA score proved significantly superior in clinical consequences to the block group at any corresponding time point postoperatively(P<0.05). At 12 months postoperatively, the cutting off group proved significantly superior to the block group in excellent and good rate of the clinical outcomes graded by modified MacNab criteria(94.59% versus 45.95%, P<0.05). [Conclusion] Endoscopic neurectomy of dorsal medial branch of spine nerve does achieve satisfactory clinical outcomes for chronic low back pain secondary to lumbar spine surgery.
[Objective] To explore the clinical outcomes of endoscopic neurectomy of dorsal medial branch of spine nerve for chronic low back pain secondary to lumbar spine surgery. [Methods] From August 2015 to December 2017, 74 patients with chronic low back pain after lumbar spine surgery in our hospital were selected as the subjects who were divided into two groups by random number method in this study. Of the patients, 37 patients underwent endoscopic neurectomy of dorsal medial branch of spine nerve by radiofrequency ablation(the cutting off group), while the remaining 37 patients received the nerve block(the block group). The visual analogue scale(VAS) for pain, the Japanese Orthopedic Society(JOA) score and modified MacNab criteria were compared before and after treatment. [Results] All patients had the treatment conducted successfully. Compared with those preoperatively, the VAS significantly decreased, whereas the JOA scores significantly increased at 1 month after operation in both group(P<0.05). After that, in the cutting off group the VAS continued to decline, while JOA score continued to elevate over time, with no significant difference among time points postoperatively(P>0.05). By contrast, in the lock group the VAS increased again, whereas the JOA score decreased once more with no significant difference among time points postoperatively(P>0.05). In addition, the cutting off group with lower VAS and higher JOA score proved significantly superior in clinical consequences to the block group at any corresponding time point postoperatively(P<0.05). At 12 months postoperatively, the cutting off group proved significantly superior to the block group in excellent and good rate of the clinical outcomes graded by modified MacNab criteria(94.59% versus 45.95%, P<0.05). [Conclusion] Endoscopic neurectomy of dorsal medial branch of spine nerve does achieve satisfactory clinical outcomes for chronic low back pain secondary to lumbar spine surgery.
引文
[1]彭昊,张雷,廉凯.Quadrant通道下经椎间孔椎体融合术与开放后路椎体融合术治疗腰椎滑脱症的近期疗效分析[J].临床外科杂志,2017,25(8):590-593.
[2]杨阳,金伟,查园瑜,等.脊柱内镜下脊神经背内侧支射频消融术治疗小关节源性腰痛疗效分析[J].临床外科杂志,2017,25(12):931-934.
[3]时宗庭,刘恒平,于栋,等.肌骨超声引导下精准针刀治疗腰椎关节突关节源性腰痛35例[J].中国中医骨伤科杂志,2018,(4):69-71.
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[7]沈毅弘,陈鲁峰,王庆敏.腰椎关节突关节炎源性腰痛的研究现状[J].风湿病与关节炎,2014,3(10):67-71.
[8]张家立,王东洋,伍亮,等.腰椎关节突关节源性腰痛诊疗的研究进展[J].中国全科医学,2016,19(6):729-732.
[9]姚玉龙,贾惊宇,吴添龙,等.椎间孔镜下脊神经内侧支消融术治疗小关节源性下腰痛疗效分析[J].中国矫形外科杂志,2015,23(7):600-604.
[10]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.
[11]彭亦良,胡安惠,张彦,等.局部封闭联合超短波治疗腰椎小关节综合征的前瞻性随机对照研究[J].临床军医杂志,2014,42(1):52-55.
[12]Yeung A,Gore S.Endoscopically guided foraminal and dorsal rhizotomy for chronic axial back pain based on cadaver and endoscopically visualized anatomic study[J].Int J Spine Surg,2014,1(12):8-10.
[13]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,2013,18(4):188-193.2018-05-24
[2]杨阳,金伟,查园瑜,等.脊柱内镜下脊神经背内侧支射频消融术治疗小关节源性腰痛疗效分析[J].临床外科杂志,2017,25(12):931-934.
[3]时宗庭,刘恒平,于栋,等.肌骨超声引导下精准针刀治疗腰椎关节突关节源性腰痛35例[J].中国中医骨伤科杂志,2018,(4):69-71.
[4]朱谦,刘波涛,杨崇林,等.腰脊神经后内侧支射频毁损在腰椎术后腰痛治疗中的应用[J].中国疼痛医学杂志,2014,20(6):405-407、411.
[5]杨国强,郭岩凤.内窥镜下脊神经背内侧支切断术治疗腰椎小关节综合征的临床疗效分析[J].颈腰痛杂志,2016,37(5):380-383.
[6]白一冰,李嵩鹏,简伟,等.椎间孔镜下侧隐窝减压治疗腰椎管狭窄的疗效分析[J].中国疼痛医学杂志,2014,20(12):919-921.
[7]沈毅弘,陈鲁峰,王庆敏.腰椎关节突关节炎源性腰痛的研究现状[J].风湿病与关节炎,2014,3(10):67-71.
[8]张家立,王东洋,伍亮,等.腰椎关节突关节源性腰痛诊疗的研究进展[J].中国全科医学,2016,19(6):729-732.
[9]姚玉龙,贾惊宇,吴添龙,等.椎间孔镜下脊神经内侧支消融术治疗小关节源性下腰痛疗效分析[J].中国矫形外科杂志,2015,23(7):600-604.
[10]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.
[11]彭亦良,胡安惠,张彦,等.局部封闭联合超短波治疗腰椎小关节综合征的前瞻性随机对照研究[J].临床军医杂志,2014,42(1):52-55.
[12]Yeung A,Gore S.Endoscopically guided foraminal and dorsal rhizotomy for chronic axial back pain based on cadaver and endoscopically visualized anatomic study[J].Int J Spine Surg,2014,1(12):8-10.
[13]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,2013,18(4):188-193.2018-05-24