高电压长时程脉冲射频术与低温等离子消融术治疗颈源性头痛的疗效比较

Effectiveness of high voltage long duration pulsed radiofrequency versus low temperature plasma radiofrequence ablation in the treatment of cervicogenic headache

目的比较低温等离子消融术与高电压长时程脉冲射频术治疗颈源性头痛(cervicogenic headache,CEH)的疗效和安全性。方法收集颈源性头痛患者80例,按照手术方式分为两组:低温等离子消融组(L组,n=50);高电压长时程脉冲射频组(H组,n=30)。L组采用颈脊神经后内侧支低温等离子消融术联合肌筋膜松解,H组采用颈脊神经后内侧支高电压长时程脉冲射频术联合肌筋膜松解。记录患者术前(T_(0))及术后1周(T_(1))、4周(T2)、12周(T_(3))、24周(T_(4))的视觉模拟评分(VAS评分)、颈部活动障碍评分(ROM评分)、术后疼痛缓解率以及术后并发症的发生率,比较两组之间的有效性和安全性。结果两组患者术后各时点的VAS评分、ROM评分均较T_(0)下降,差异有统计学意义(P<0.05);与L组相比,H组各时点的VAS评分均降低,差异有统计学意义(P<0.05),H组各时点的ROM评分均降低,差异无统计学意义(P>0.05),T_(4)时点H组的有效率高于L组,差异有统计学意义(P<0.05)。两组术后均有头皮麻木的情况,T_(3)时点H组的麻木发生率稍高于L组,差异有统计学意义(P<0.05)。结论低温等离子消融术和高电压长时程脉冲射频术治疗颈源性头痛均有效,安全性均较好,但高电压长时程脉冲射频术术后24周的疗效优于低温等离子消融术。

Objective To compare the short⁃term efficacy and safety of low temperature plasma radiofre⁃quence ablation(LA)vs.high voltage long duration pulsed radiofrequency(HL⁃PRF)in the treatment of cervico⁃genic headache(CEH).Methods Eighty patients with cervicogenic headache were divided two groups:one treated with low temperature plasma radiofrequence ablation group as group L(n=50)and the other treated with high voltage long duration pulsed radiofrequency group as group H(n=30).The two groups were compared in terms of the score by the Visual Analog Scale,score by the Range of Motion Scale,postoperative pain relief rate,postop⁃erative complication incidence,1,4,12,and 24 weeks after the operation,as well as the therapeutic effectiveness and safety.Results Both groups showed significantly lower VAS and ROM scores after operation(P<0.05).Compared with group L,group H had significantly lower VAS(all P<0.05)but insignificantly lower ROM scores(all P>0.05)at each time point.At T_(4),group H had significantly higher therapeutic effectiveness rate(P<0.05)and higher incidence of scalp numbness at T_(3),as compared to group L(P<0.05).Conclusion The low tempera⁃ture plasma radiofrequency ablation and high voltage long duration pulsed radiofrequency both are effective and safe in the treatment of CEH,the latter approach can achieve better therapeutic effectiveness 24 weeks after the operation than the former.