低温等离子消融术与脉冲射频治疗颈源性头痛的疗效及安全性分析

Analysis of the efficacy and safety of coblation and pulsed radiofrequency in the treatment of cervicogenic headache

目的探讨低温等离子消融术与脉冲射频治疗颈源性头痛(CEH)的疗效与安全性。方法采用回顾性队列研究的方法,收集2018年8月至2020年6月在首都医科大学宣武医院疼痛科行低温等离子消融术或脉冲射频治疗的CEH患者118例。根据患者所接受的手术方式不同,分为低温等离子消融术组(n=64)和脉冲射频组(n=54)。低温等离子消融术组中,男14例,女50例,年龄29~65(49.8±10.2)岁;脉冲射频组中,男24例,女30例,年龄18~65(41.7±14.8)岁。记录并比较两组患者手术前以及术后3 d、1个月、3个月、6个月的视觉模拟评估量表(VAS)评分、术后病变区域麻木的发生情况,以及术后并发症的发生情况。结果低温等离子消融术组术前以及术后3 d、1个月、3个月、6个月VAS评分分别为(7.16±0.91)、(3.67±1.13)、(1.59±0.91)、(1.66±0.84)、(1.56±0.90)分,脉冲射频组分别为(7.01±0.78)、(1.58±0.88)、(1.57±0.94)、(3.71±1.08)、(6.92±0.83)分。组间比较:低温等离子消融术组与脉冲射频组在术后3 d、3个月、6个月的VAS评分差异均有统计学意义(均P<0.001)。组内比较:低温等离子消融术组术后各时间点VAS评分较术前均有明显下降(均P<0.001);脉冲射频组术后3 d、1个月、3个月VAS评分较术前均有明显下降(均P<0.001)。低温等离子消融术组术后3 d、1个月、3个月、6个月麻木发生率分别为72%(46/64)、61%(39/64)、6%(4/64)、3%(2/62),脉冲射频组分别为7%(4/54)、7%(4/54)、2%(1/54)、0(0/54);其中,在术后3 d、1个月时,低温等离子消融术组麻木发生率高于脉冲射频组(均P<0.001)。低温等离子消融术组1例患者在术后3 d出现咽部不适症状,未经特殊处理,术后1周该症状自行消失;1例患者在术后3 d出现晨起后眩晕症状,考虑短暂性脑缺血可能。脉冲射频组1例患者术后出现恶心、呕吐,未予特殊处理,观察1 h后自行缓解。结论低温等离子消融术与脉冲射频治疗CEH均有效,安全性均较好,但低温等离子消融术组术后3~6个月的VAS评分明显低于脉冲射频组,疗效优于脉冲射频。

Objective To explore the efficacy and safety of coblation and pulsed radiofrequency on cervicogenic headache(CEH).Methods A total of 118 patients with CEH who underwent coblation or pulsed radiofrequency in the Department of Pain Management at Xuanwu Hospital,Capital Medical University from August 2018 to June 2020 was retrospectively collected.Patients were divided into the coblation group(n=64)and the pulsed radiofrequency group(n=54)according to different surgical methods.In the coblation group,there were 14 males and 50 females,aged 29-65(49.8±10.2)years,while in the pulse radiofrequency group,there were 24 males and 30 females,aged 18-65(41.7±14.8)years.Visual analogue scale(VAS)score,postoperative numbness in the affected areas and other complications were recorded and compared between the two groups at preoperative 3 d,and 1 month,3 months and 6 months postoperatively.Results The VAS score of the coblation group was(7.16±0.91),(3.67±1.13),(1.59±0.91),(1.66±0.84)and(1.56±0.90)before operation,and 3 days,1 month,3 months and 6 months after surgery.Likewise,the VAS score of the pulsed radiofrequency group was(7.01±0.78),(1.58±0.88),(1.57±0.94),(3.71±1.08)and(6.92±0.83)at the aforementioned time points.There were statistically significant differences of VAS scores between the coblation group and the pulsed radiofrequency group at 3 days,3 months and 6 months postoperatively(all P<0.001).Intra-group comparison revealed that VAS scores in the coblation group were significantly lower than those before surgery at all time points after surgery(all P<0.001),while VAS scores in the pulsed radiofrequency group were significantly decreased at 3 days,1 month and 3 months after surgery(P<0.001).The incidence of numbness was 72%(46/64),61%(39/64),6%(4/64)and 3%(2/62)in the coblation group and 7%(4/54),7%(4/54),2%(1/54)and 0(0/54)in the pulsed radiofrequency group,respectively.At 3 days and 1 month after surgery,the incidence of numbness in the coblation group was higher than those in the pulsed radiofrequency group(both P<0.001).In the coblation group,one patient developed pharyngeal discomfort 3 days after surgery,which disappeared spontaneously 1 week after surgery without special treatment.One patient developed vertigo after getting up in the morning at 3 days postoperatively,and the possibility of transient cerebral ischemia was considered.In the pulsed radiofrequency group,one patient developed nausea and vomiting after operation,but spontaneous remission was observed after one hour without special treatment.Conclusions Both coblation and pulsed radiofrequency are effective and safe in the treatment of CEH.But the VAS scores at 3 and 6 months after coblation is significantly lower than those of pulsed radiofrequency ablation group,and the efficacy is better in those undergoing coblation.