对退行性腰椎关节源性腰痛行脊神经后支标准射频手术治疗的随机对照研究

PERCUTANEOUS RADIOFREQUENCY NEUROTOMY FOR DEGENERATIVE LUMBAR FACETRELATED LUMBAGO: A RANDOMIZED CONTROLLED STUDY

目的:通过随机对照研究,评价腰脊神经后支标准射频术治疗退行性腰椎关节源性腰痛的安全性和有效性。方法:选取2008年6月至2010年6月间广东医学院附属南山医院患者96名纳入研究,所有患者均经诊断性腰椎脊神经后支阻滞有效,明确为腰椎关节源性腰痛。随后随机分为2组,A组采用X线影像引导下腰脊神经后支射频热凝术治疗,B组采用口服药物保守治疗,随访期2年。利用视觉模拟评分法(visual analogue scores,VAS)进行治疗前后疗效评定。以VAS评分小于治疗前的50%视为优良疗效,反之视为疗效不佳。利用Kaplan-Meier生存曲线与Log-Rank检验进行2组疗效对比。记录手术并发症与用药不良发应。结果:A组VAS评分回到术前50%的平均时间是196 d,B组为35 d(P<0.01)。在第27周(治疗后200 d),A组32名患者疗效评价仍为优良,B组为1名。A组疗效优良率显著高于B组(P<0.01)。B组15例患者出现胃部不适,纳差,经对症治疗后消失。A组2例患者术后出现神经支配区域的皮肤麻木,无感染及脊神经前支损伤等并发症。结论:对于退行性腰椎小关节源性腰痛,腰椎脊神经后支射频热凝术相比保守治疗,能够更有效的长期缓解疼痛,且操作安全,不良反应很少。

Objective： To evaluate the efficacy of percutaneous radiofrequency thermocoagulation on posterior ramus of lumbar spinal nerve for treatment in patients with degenerative lumbar facet-related lumbago through a randomized controlled study.Methods： A total of 96 patients with lumbar facet-related lumbago treated in the Affiliated Nanshan Hospital of Guangdong Medical College from June 2008 to June 2010 were enrolled into this study.All patients had a diagnosis of lumbar facet-related lumbago established by controlled blocks on lumbar ramus of posterior spinal nerve and were randomly divided into two groups.Under the guidance of digital subtraction angiography（DSA）,group A were treated with percutaneous radiofrequency thermocoagulation on lumbar ramus of posterior spinal nerve,while group B received the conservative treatment of oral non-steroidal antiinflammatory drugs（NSAIDs）.The curative effects before and after treatment was evaluated by visual analog scores（VAS）.Good efficacy was defined as post-treatment VAS scores less than 50% of pre-treatment VAS scores,while the rest were defined as poor efficacy.The Kaplan-Meier curve and the Log-Rank test were used for comparison between the two groups.Adverse drug reactions and operation complications were recorded.Results： The mean time period for VAS scores to return to 50% of the preoperative level was 196 days in the group A and 35 days in the group B（P 0.01）.At 27 weeks（200 d after treatment）,32 patients in the group A and 1 patient in the group B showed good efficacy.The efficacy rate in the group A was significantly higher than that in the group B（P 0.01）.Fifteen patients in the group B had gastragia and anorexia,which were resolved after symptomatic treatment.Two patients in the group A had numbness in the innervations area of the treated nerves,without complications such as infection and anterior ramus impairment.Conclusion： In patients with degenerative lumbar facet-related lumbago,compared with conservative treatment,percutaneous radiofrequency thermocoagulation of target nerves can provide more effective long-term pain-relieving effect,and it is safe with less adverse reactions.