椎间孔镜下脊神经内侧支消融术治疗小关节源性下腰痛疗效分析

Analysis of clinical effects of spinal nerve medial branch ablation through transforaminal endoscopic in treatment of small arthrogenous lower back pain

[目的]探讨椎间孔镜下脊神经背内侧支消融术治疗小关节源性下腰痛的临床应用价值和有效性。[方法]自2013年1月~2014年2月本科采用腰椎小关节突封闭确诊并收治小关节源性腰痛患者52例。所有病例分为2组：A组30例采用椎间孔镜下脊神经内侧支消融术治疗;B组22例接受非甾体类消炎药治疗。所有患者术后随访8~15个月,平均12个月,记录治疗前,治疗后1、3、6及12个月时两组患者腰椎视觉模拟评分（VAS）和改良下腰痛日本骨科学会（JOA）评分并进行比较。[结果]两组患者治疗后腰痛均有所缓解,A组术后各时间点VAS和JOA评分与术前相比差异具有统计学意义（P〈0.05）,术后各时间点之间比较差异无统计学意义（P〉0.05）;B组治疗3个月后各时间点VAS和JOA评分较治疗前差异无统计学意义（P〉0.05）,治疗后3个月和12个月时两组间VAS和JOA评分比较A组疗效优于B组（P〈0.05）。此外,B组治疗后8 d有2例出现胃部不适,对症治疗后好转。[结论]椎间孔镜下脊神经内侧支消融术是一种有效的微创脊柱外科技术,联合小关节封闭对小关节源性下腰痛的诊断与治疗具有重要的临床应用价值。

[Objective] To prospectively investigate the clinical value and effectiveness of spinal nerve medial branch ablation through transforaminal endoscopic in treatment of small arthrogenous lower back pain. [Methods] From January 2013 to February 2014,52 patients with small arthrogenous lower back pain diagnosed by lumbar facet injection were admitted to hospital. All patients were divided into 2 groups： 30 patients in group A were treated by spinal nerve medial branch ablation through transforaminal endoscopic; 22 patients in group B were treated with non-steroidal anti-inflammatory drugs. All patients received follow-up of 8 ~ 15 months,averaged 12 months,the visual analogue scale（ VAS） and Japanese Orthopaedic Association（ JOA） scores before treatment,1 months after treatment,3months after treatment,6 months and 12 months after treatment were recorded and analyzed. [Results] The back pain had eased in both A and B groups after treatment,the VAS and JOA of group A in preoperation showed significant difference compared with postoperation（ P〈0. 05）,and there was no significant difference at each time point after treatment（ P〉0. 05）. The VAS and JOA of group B in preoperation showed no significant difference compared with postoperation（ P〉0. 05）,but at 3 and 12 month after treatment the VAS and JOA of group A showed difference compared with group B（ P〈0. 05）. Moreover,two patients of group B complained stomach discomfort taking non-steroidal anti-inflammatory drugs eight days after treatment,and the symptom eased after symptomatic treatment. [Conclusion] The spinal nerve branches ablation under transforaminal endoscopic is an effective minimally invasive spine surgery technique,in combination with spinal nerve medial branch injection,it will have an important role in diagnosis and treatment of small arthrogenous lower back pain.