腰脊神经后内侧支射频毁损在腰椎术后腰痛治疗中的应用

RADIOFREQUENCy ABLATION OF MEDIAL BRANCH OF POSTERIOR LUMBAR RAMUS IN THE TREATMENT OF FAILED BACK SURGERy SyNDROME

目的:观察腰脊神经后内侧支射频毁损治疗腰椎术后腰痛的有效性。方法:40例临床诊断腰椎术后腰痛患者,随机分为脊神经后支射频毁损组(R组)和脊神经后支阻滞组(B组),在X线透视引导下行双侧腰脊神经后内侧支射频毁损或阻滞,评价患者治疗前、治疗后5 min、1周、4周和12周时的腰痛VAS评分和腰椎活动度,记录治疗中和治疗后的并发症。结果:两组患者治疗前VAS评分和腰椎活动度的基础值无明显差异(P>0.05),治疗后5 min、1周时的VAS评分明显低于基础值(P<0.05),腰椎活动度明显高于基础值(P<0.05)。治疗后4周、12周时的VAS评分和腰椎活动度与基础值比较,B组无明显差异(P>0.05),R组VAS评分明显低于基础值,腰椎活动度明显高于基础值(P<0.05)。两组治疗后5 min、1周时的VAS评分和腰椎活动度相近(P>0.05),但R组治疗后4周、12周时的VAS评分明显低于B组(P<0.05),腰椎活动度明显高于B组(P<0.05)。结论:腰脊神经后内侧支射频毁损是治疗腰椎术后腰痛的有效方法。

Objective：To observe the effect of radiofrequency ablation of medial branch of posterior lumbar ramus in the treatment of lumbar pain resulting from failed back surgery syndrome （FBSS）.Methods：Bilateral radiofrequency ablation of medial branch of posterior lumbar ramus under X-ray was performed in 40 patients with clinical diagnosis of FBSS.The effect of the treatment was assessed by visual analogue scale （VAS） and back movementss at 5 min,1,4 and 12 weeks after procedure.The complications,if any,were recorded.Results：The difference of pre-procedure VAS score and back movements between both groups was not significant （P 〉 0.05）.The VAS score was lower and back movements was greater significantly in both groups at 5 min and 1 week after procedure than pre-procedure baseline value （P 〈 0.05）.The VAS score and back movements in group B at 4 and 12 weeks after procedure were similar with pre-block baseline value （P 〉 0.05）,but VAS score was lower and back movements was greater significantly compared with pre-procedure baseline value in group R （P 〈 0.05）.Although there was no significant difference in VAS score and back movements at 5 min and 1 week after procedure between both groups （P 〉 0.05）,the VAS score was lower and back movements was significantly greater at 4 and 12 weeks in group R than that in group B （P 〈 0.05）.No complication occurred in both groups.Conclusion：Radiofrequency ablation of medial branch of posterior lumbar ramus is an effective procedure for treatment of lumbar pain resulting from FBSS.