颈2背根神经节脉冲射频术治疗颈源性头痛的疗效

Efficacy of pulsed radiofrequency application to C2 dorsal root ganglion for the treatment of cervicogenic headache

本院2007年6月-2009年6月行颈2背根神经节脉冲射频术的颈源性头痛患者74例，年龄26～63岁，病程3个月～21年。术后随访18个月，行疼痛评分、生活质量参数（日常活动干扰参数、情绪干扰参数、睡眠干扰参数）评估，记录并发症发生情况和术后12、18月内头痛的复发情况。失访22例患者。与术前1d时比较，术后VAS评分、日常活动干扰参数、情绪干扰参数、睡眠干扰参数降低（P〈0．05或0．01）。部分患者在术后当晚出现一过性的枕神经支配区域不适，24h内缓解。无颈髓损伤、椎动脉损伤和感染等并发症发生。术后12、18月内头痛复发率分别为19％、31％。

Seventy-four patients aged 26-63 yr who had suffered cervicogenic headache for 3 months-21 yr were treated with pulsed radiofrequency applied to C2 dorsal root ganglion, which is located in the middle of the posterior side of lateral atlantoaxial joint. A trochar was introduced percutaneously under the guidance of X-ray aiming at the target point. As it was inserted through the deep fascia, the styler was withdrawn and a 10 cm long 22 gauge curved blunt electrode was inserted into the trochar and advanced until the patients felt radiating pain from the point of puncture to occiput. Lateral radiograph was obtained to verify the placement of electrode. The tip of the electrode was usually located in front of spinal canal at the atlantoaxial joint level. Sensory stimulation was performed with 50 Hz and 0.1,0.5 V and the patients could feel radiating pain at occiput. Motor stimulation was performed with 2 Hz and 0.4-1.0 V and regular pulsation of the patient＇ s muscle of occiput could occur. Pulsed radiofrequency was applied at 42 % for 240 s and was performed twice on each side. VAS scores and disturbances of daily activity, mood and sleep were recorded before operation and at 1 week and 1, 3, 6, 12 and 18 months after pulsed radiofrequency treatment. Complications and recurrence within 12 and 18 months were recorded. Follow-up was lost in 22 patients. VAS scores and disturbances of daily activity, mood and sleep significantly decreased after procedure. All of the patients responded without complications like infection, spinal cord and vertebral artery injury. Some patients had transient occipital neuralgia which was usually relieved within 24 h. The recurrence rate in 12 and 18 months after operation was 19% and 31% respectively.