超声引导下颈脊神经后内侧支射频热凝在慢性颈肩痛的疗效观察
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摘要
目的:观察超声引导下行颈椎脊神经后内侧支射频热凝治疗慢性颈肩部疼痛的临床疗效及安全性。方法:2015年至2016年40例明确诊断为颈椎脊神经后支诱发的慢性颈肩痛病人,采用随机数字表法分成两组,每组20例,A组采用超声引导下颈椎关节突关节平面脊神经后内侧支射频热凝治疗,B组均采用口服药物+针灸、推拿保守治疗。观察两组病人治疗后1天、5天、10天、1月、3月、6月、12月的视觉模拟评分法(visual analog scale,VAS)评分。记录A组病人治疗前后颈部的痛温觉变化(减退或消失为有效,无改变为无效)。记录射频热凝的并发症和药物不良反应。结果:A组治疗后的每个时间点VAS评分降低与治疗前相比有统计学意义(P均<0.05);B组病人治疗后5天、10天VAS评分降低与治疗前相比具有统计学差异(P<0.05),其他时间点与治疗前相比无统计学差异;A组和B组治疗后的每个时间点比较均有统计学差异(P<0.05)。结论:在超声引导下行颈脊神经后内侧支射频热凝治疗慢性颈肩部痛,能够更有效的长期缓解疼痛,且操作安全易行,副作用很少,值得推广。
Objective: To observe the clinical feasibility, accuracy, efficacy and safety of posterior medial branch of cervical dorsal rami radiofrequency thermocoagulation under the guidance of ultrasound in patients with chronic cervical and shoulder pain. Methods: Forty patients with chronic cervical and shoulder pain were divided into two groups: 20 cases in each group. Group A was treated with ultrasound-guided posterior medial branch of cervical dorsal rami radiofrequency thermocoagulation. Group B was treated with analgesics combined with acupuncture. The changes of pain and temperature sensation(loss or disappearance were effective and no change was invalid) were recorded before and after treatment in group A. The VAS scores after the treatment from both groups were recorded and compared till the 12 th month. The complications of radiofrequency thermocoagulation and adverse effect of drugs were recorded. Results: The VAS scores in group A at different time points after treatment were significantly lower than that before treatment(P < 0.05). There was a significant difference between the VAS scores on the 5th day and the 10 th day after treatment in group B compared with that before treatment(P < 0.05). There was no significant difference on the first month after treatment(P > 0.05). There are obvious differences between two groups at these time points after treatment(P < 0.05). Conclusion: Radiofrequency thermocoagulation under the guidance of ultrasound can provide lasting relief in patients with chronic cervical and shoulder pain confirmed with target nerves.
Objective: To observe the clinical feasibility, accuracy, efficacy and safety of posterior medial branch of cervical dorsal rami radiofrequency thermocoagulation under the guidance of ultrasound in patients with chronic cervical and shoulder pain. Methods: Forty patients with chronic cervical and shoulder pain were divided into two groups: 20 cases in each group. Group A was treated with ultrasound-guided posterior medial branch of cervical dorsal rami radiofrequency thermocoagulation. Group B was treated with analgesics combined with acupuncture. The changes of pain and temperature sensation(loss or disappearance were effective and no change was invalid) were recorded before and after treatment in group A. The VAS scores after the treatment from both groups were recorded and compared till the 12 th month. The complications of radiofrequency thermocoagulation and adverse effect of drugs were recorded. Results: The VAS scores in group A at different time points after treatment were significantly lower than that before treatment(P < 0.05). There was a significant difference between the VAS scores on the 5th day and the 10 th day after treatment in group B compared with that before treatment(P < 0.05). There was no significant difference on the first month after treatment(P > 0.05). There are obvious differences between two groups at these time points after treatment(P < 0.05). Conclusion: Radiofrequency thermocoagulation under the guidance of ultrasound can provide lasting relief in patients with chronic cervical and shoulder pain confirmed with target nerves.
引文
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[14]廖翔,蒋劲,熊东林,等.颈椎脊神经后支射频热凝术有效性的随机对照研究.中国疼痛医学杂志,2011,17(12):732~735.
[15]朱紫瑜,郑拥军,王祥瑞.超声引导下行颈脊神经后内侧支阻滞治疗颈椎小关节综合征.上海医学,2012,35(2):122~124,171.
[2]李文元,丛伟红,颜传竹,等.快刺法治疗颈型颈椎病的疗效观察.中国针灸,2017,37(09):951~954.
[3]Mac Pherson H,Tilbrook H,Richmond S,et al.Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain:A Randomized Trial.Ann Intern Med,2015,163(9):653~662.
[4]任浩,罗芳.脉冲射频治疗慢性伤害感受性疼痛的临床应用进展.中国疼痛医学杂志,2016,22(1):59~63.
[5]Barnsley L.Percutaneous radiofrequency neurotomy for chronic neck pain:outcomes in a series of consecutive patients.Pain Med,2005,6:282~286.
[6]张伟波,周海平,严火荣,等.C型臂定位下颈脊神经后内侧支阻滞治疗颈肩痛.中国疼痛医学杂志,2011,17(6):382~384.
[7]姜永庆,董大明,王岩松.关节突关节射频热凝治疗颈脊神经后支引起慢性颈肩臂痛的临床报道.中国疼痛医学杂志,2004,10(5):310~311.
[8]王金武,陈德松,王劼,等.颈神经后支的解剖及其临床意义.中国临床解剖学杂志,2001,2:104~107.
[9]郭雪娇,彭志友,冯智英.脊椎小关节介入治疗在慢性脊柱源性疼痛应用进展.中国疼痛医学杂志,2016,22(11):801~805.
[10]杨俊,钟琼,付敏,等.CT引导下弯针脊神经后支射频术治疗颈椎轴性痛有效性的临床研究.赣南医学院学报,2016,36(4):519~522.
[11]Gofeld M.Ultrasonography in pain practice:moving on.Pain Pract,2014,14(5):397~398.
[12]漆海如,曾宪明,陈强,等.射频热凝与神经阻滞治疗颈神经后支源性慢性颈肩痛及头痛随机对照研究.中华临床医师杂志(电子版),2016,10(09):1338~1341.
[13]Chua NH,Vissers KC,Sluijter ME.Pulsed radiofrequency treatment in interventional pain management:mechanisms and potential indications-a review.Acta Neurochir(Wien),2011,153(4):763~771.
[14]廖翔,蒋劲,熊东林,等.颈椎脊神经后支射频热凝术有效性的随机对照研究.中国疼痛医学杂志,2011,17(12):732~735.
[15]朱紫瑜,郑拥军,王祥瑞.超声引导下行颈脊神经后内侧支阻滞治疗颈椎小关节综合征.上海医学,2012,35(2):122~124,171.