超声引导下内热针治疗颈源性头痛的临床研究

Ultrasound-guided dry needle of inner heating for the treatment of patients with cervicogenic headache

目的 研究超声引导下内热针治疗颈源性头痛(CEH)的安全性和有效性.方法 选取2017年3月至2018年3月期间在广东省佛山市禅城区中心医院麻醉科就诊的CEH患者共64例,按照随机数字表法分为盲穿组和超声组(n=32).盲穿组在局部麻醉后依据体表标志行内热针穿刺治疗,超声组于局部麻醉后在超声引导下进行内热针穿刺治疗.比较两组患者操作时间、治疗前和治疗结束后7d、14d和1个月时VAS评分、疗效,以及并发症,如血肿、感染、神经损伤等.结果 两组患者治疗后头痛程度VAS评分均明显下降,与治疗前相比差异有统计学意义.VAS评分治疗后7d、14d时,超声组与盲穿组比较差异无统计学意义;超声组VAS 0~3例数均多于盲穿组,但差异无统计学意义;治疗后1个月时,超声组患者VAS评分低于盲穿组;超声组患者VAS 0~3例数(28/32)多于盲穿组(21/32),差异均有统计学意义(P<0.05),超声组内热针治疗后血肿发生率(0/32)显著低于盲穿组(3/32),但操作时间显著增长(P<0.05).结论 内热针超声引导下穿刺与盲穿法治疗颈源性头痛均有显著疗效,近期疗效两法相似,但远期疗效超声引导法优于盲刺法,且并发症发生率较低.

Objective To evaluate the efficacy of ultrasound-guided dry needle with inner heating for the treatment of patients with cervicogenic headache (CEH).Methods Sixty-four patients with CEH were randomly divided into two groups,thirty-two cases in each group.After local anesthesia,patients were treated with inner heating dry needle on the body landmarks in the blind puncture group,and patients were treated under ultrasound guidance in the ultrasound group.The treatment time,therapeutic effects and complications such as local hematoma or infection were analyzed in the two groups.Results VAS was significantly decreased after the treatment in the two groups (P<0.05).There was no significant difference in VAS between the ultrasound group and the blind puncture group at 7 and 14 days after the treatment.At 1 month after treatment,the VAS was lower in the ultrasound group than that in the blind puncture group;the number of VAS 0-3 cases were less in the blind puncture group (21/32) than those in the ultrasound group (28/32) with statistical significance (P<0.05).After the treatment,the incidence of hematoma was significantly lower in ultrasound group (0/32) than that in blind puncture group (3/32),but the treatment time increased significantly in the ultrasound group (P<0.05).Conclusion The effects of inner heating dry needle punctured by ultrasound guidance or by blind are similar in the short-term in the treatment of patients with cervicogenic headache,but the outcome is superior in the long-term by ultrasound guidance than that by blind puncture,and the incidence of complications is lower under ultrasound guidance.