超声引导下颈神经根脉冲射频治疗带状疱疹神经痛的临床研究

Ultrasound-guided cervical nerve root radiofrequency on herpes zoster neuralgia

目的:探讨超声引导下颈神经根脉冲射频治疗上肢带状疱疹神经痛的临床疗效。方法:采用前瞻性随机对照研究方法,符合入组标准的上肢带状疱疹神经痛病人采用随机数字表法分为超声组(n=36)和透视组(n=37)。受累颈神经根超声引导下脉冲射频42℃360 s。主要终点指标:术后1天、2周、4周、12周和24周疼痛数字评分法(numerical rating scale,NRS)评分。次要终点指标:镇痛药和钙通道拮抗剂使用情况。结果:超声组和透视组术后1天、第2周和第4周NRS分别降至4.0 vs.5.4(P<0.01)、3.4 vs.4.6(P<0.05)、3.0 vs.3.9(P<0.05)。术后第1天超声组和透视组分别有8例和3例停用镇痛药(P<0.05)。超声组平均手术时间30 min,明显低于透视组(P<0.01)。结论:超声引导下颈神经根脉冲射频能快速持久减轻上肢带状疱疹神经痛,短期疗效优于透视组,且手术时间明显缩短。

Objective:To explore the clinical effects of ultrasound-guided cervical nerve root pulse radiofrequency procedure on herpes zoster neuralgia of upper limb.Methods:A prospective,randomized,controlled study was conducted in patients with neuralgia due to herpes zoster of upper limb.They were divided into ultrasound group(n=36)and fluoroscopic group(n=37).The target nerve roots received pulse radiofrequency procedure at 42℃360 s.Main outcome measure was numerical rating scale(NRS)of pain suffering at the 1st day,2nd,4th,12th and 24th weeks after operation.The secondary end points were the use of analgesics and calcium channel antagonists.Results:The NRS pain score of ultrasound group and fluoroscopy group decreased to 4.0 vs.5.4 on the 1st day after operation(P<0.01),3.4 vs.4.6 on the 2nd week(P<0.05),3.0 vs.3.9 on the 4th week(P<0.05).On the first day after operation,8 cases in ultrasound group and 3 cases in fluoroscopy group stopped using analgesics(P<0.05).The average operation time of ultrasound group was 30 minutes,significantly shortened than that of fluoroscopy group(P<0.01).Conclusion:Ultrasound-guided cervical nerve root pulsed radiofrequency can relieve upper limb herpes zoster neuralgia rapidly and enduring,the short-term analgesic effect is better than the fluoroscopy group,and the operation time was significantly shortened.