射频热凝和臭氧注射对腰椎间盘突出患者的疗效及其电生理评估意义

Therapeutic effect of radiofrequency thermocoagulation plus ozone injection and the significance of electromyaographic evaluation in patients with lumbar disc herniation

目的评估射频热凝联合臭氧注射（RFTC—OI），对腰椎间盘突出（LDH）患者的疗效及其电生理检测的意义。方法收集2011年9月-2013年1月就诊的LDH患者，符合纳入标准者50例，随机分为2组，试验组25例，采用CT下靶椎间盘RFTC—OI治疗；对照组25例，采用椎旁注射镇痛液治疗。在治疗后第1、7、30d比较2组间视觉模拟评分法（VAs）评分、总有效率以及电生理检测的变化。结果患侧下肢运动和感觉神经传导速度均无异常，2组胫神经F波和H反射潜伏期均延长（P〈0．05），治疗后30d与治疗前无明显差异；与治疗前比较，治疗后2组VAS评分均减低（P〈0．05），治疗后30d，试验组低于对照组（P〈0．05）；治疗后30d，试验组总有效率高于对照组（P〈0．05）。结论射频热凝联合臭氧注射是治疗LDH所致疼痛的有效方法，其疗效优于椎旁注射镇痛剂；电生理检测应用于监测疗效的意义不大。

Objective To evaluate the therapeutic effect of intra-discal radiofrequency thermocoagulation plus intra-discal and extra-discal ozone injection （RFTC-OI） and the significance of electromyaographic testing in patients with LDH. Methods Fifty LDH patients between September, 2011 and January, 2013, who met the inclusion criteria, were enrolled. The patients were randomly divided into two groups, each 25 cases. In trial group, target intradiscal RFTC-OI under CT guidance was performed; in control group, paravertebral in- jection of analgesic liquid was applied. After 1 day, 7 and 30 days of treatment, the visual analogue scale （VAS）, total effective rate and the electrophysiologic index were compared between the two groups. Results 1） Electrophysiologic parameters： In the two groups, there was no abnormalities of motor and sensory nerve conduction velocity on the affected lower limb, F-wave and H-reflex latencies of tibial nerve prolonged （P〈0. 05）, with no significant difference between pre- and post-treatment. 2） VAS; The scores were decreased after treatment in both groups, compared with those before treatment （P〈0. 05）; furthermore, the score in the trial group was lower than that in the control group （P〈0. 05）. 3） Total effective rate in the trial group was higher than that in the control group （P〈0. 05）, with 96% and 68%, respectively. Conclusions RFTC-OI is an effective way to treat pain caused by LDH, and the efficacy is superior to the paraspinal injection of analgesics; whereas the late response is less meaningful for monitoring of the therapeutic efficacy.