不同档位脊神经后支低温等离子消融术治疗慢性关节突关节源性腰痛

Low-temperature plasma radiofrequency ablation at different level of the posterior branch of the spinal nerve for the treatment of chronic lumbar facet joint pain

目的:探讨不同档位的低温等离子消融术(low-temperature plasma radiofrequency ablation,LTPRA)治疗慢性关节突关节源性腰痛的临床疗效及安全性,为临床提供理论依据。方法:纳入2021年2月至2022年2月在中日友好医院疼痛科接受LTPRA治疗的92例慢性关节突关节源性腰痛住院病人,根据LTPRA治疗的档位分为1档组(平均功率13 W,术区温度40℃左右,51例)与3档组(平均功率49 W,术区温度60℃左右,41例)。分别对两组术前、术后第2周、1、3、6、12个月的疼痛数字分级评分法(numerical rating scale,NRS)评分、Oswestry功能障碍指数(Oswestry disability index,ODI)、非甾体抗炎药(nonsteroidal antiinflammatory drugs,NSAIDs)和/或阿片类药物的使用情况、手术相关并发症进行随访评估以及统计学分析。结果:与术前相比,术后2周、1、3、6、12个月两组NRS评分和ODI评分均明显下降;药物使用率显著下降。组间比较发现,术后1个月至12个月3档组NRS评分均低于1档组,术后2周以及术后6个月至术后12个月,3档组ODI评分均低于1档组,差异有统计学意义。3档组中更多比例病人出现术后短期轻度并发症,但差异无统计学意义。结论:针对慢性关节突关节源性腰痛,1档、3档治疗均有效,3档的治疗效果更优、持续时间更长,术后短期可能出现轻度的并发症,但术后并发症与1档相比无明显差异。

Objective:To explore the clinical efficacy and safety of low-temperature plasma radiofrequency ablation(LTPRA)of different levels in the treatment of chronic lumbar facet joint pain,providing theoretical bases for clinical practice.Methods:From February 2021 to February 2022,92 inpatients who underwent LTPRA for chronic lumbar facet joint pain in the Pain Department of the China-Japan Friendship Hospital were divided into the 1st level group(the average power was 13 W and the operative temperature was about 40℃in 51 patients)and the 3rd level group(the average power was 49 W and the operative temperature was about 60℃in 41 patients).The patients'numerical rating scale(NRS)scores,the Oswestry disability index(ODI)scores,the proportion of nonsteroidal antiinflammatory drugs(NSAIDs)and/or opioid drugs used,surgical related complications and patient satisfaction,before surgery,at the 2nd week,the 1st month,the 3rd month,the 6th month and the 12th month after surgery,were respectively followed up and statistically analyzed.Results:Compared with pre-operation,the NRS score and ODI score decreased significantly at the 2nd week,the 1st month,the 3rd month,the 6th month and the 12th month after surgery,with statistical significance.The postoperative drug use rate also decreased.Comapared with the 1st level group,the NRS scores of the 3rd level group was lower from 1st month to 12th month after operation,with statistical significance.The ODI scores of the 3rd level group was also lower than the 1st level group,at 2nd week and from 6th month to 12th month after operation,with statistical significance.More patients in the 3rd level group had short-term postoperative mild complications,but the difference was not statistically significant.Conclusion:For chronic lumbar facet joint pain,both the 1st and 3rd level LTPRA treatments are effective.Compared with the 1st level LTPRA treatment,3rd level LTPRA treatment has better efficacy with longer duration.While mild complications may occur in the short term after surgery,there is no significant difference in postoperative complications.