CT引导下弯针脊神经后支射频术治疗颈椎轴性痛有效性的临床研究

A Clinical Study on CT Guided Looper Radiofrequency Percutation in the Treatment of Cervical Axial Pain of Cervical Dorsal Rami

目的：探讨CT引导下弯针脊神经后支射频术治疗颈椎轴性痛的有效性及安全性。方法：239例颈椎轴性疼痛患者随机分为两组,A组行脊神经后支射频热凝术治疗,B组采用口服药物治疗,随访期为半年。利用视觉模拟评分法（VAS评分）评估疼痛变化及疗效,并观察相关并发症。结果：A组射频部位主要为颈2~颈5,其中74例开展同侧或双侧相邻2支节段射频热凝术（62.18%）。VAS评分对比,A组术后各观察点均较术前有显著降低（P〈0.01）,B组术后均较术前有显著降低（P〈0.01）,A组术后各观察点均较B组有显著降低（P〈0.01）;术后180 d随访,A组优良率和有效率为87.39%、96.63%,B组为23.89%、47.79%。13例患者术后出现手术节段脊神经后支支配区域范围、形态不等的皮肤浅感觉轻度下降,发生率17.57%。结论：CT引导下的弯针射频手术治疗颈椎轴性痛具有定位精确、操作安全、有效、见效快及不良反应较少的优势。

Objective： To study the efficacy and safety of percutaneous radiofrequency thermocoagulation of the medial branches of the cervical dorsal rami in patients with cervical axial pain. Methods： Two-hundred and thirty-nine patients with cervial axial pain were enrolled into this study and were radomly divided into two groups. Group A was treated with looper radiofrequency percutation and Group B was treated with drug only. Both groups were recorded for six months. The pain changes and efficacy were assessed by VAS scores. Side effects and complications were recorded. Results： The RF part of the Group A was mainly located at neck 2 ~ 5,and 74 patients were treated by radiofrequency thermal coagulation in the ipsilateral or bilateral adjacent two segments（ 62. 18%）. In comparison to scores before treatment,VAS scores of Group A and Group B decreased significantly at various time points after treatment,respectively（ P〈0. 01）. VAS scores of Group A were significantly lower than those of Group B at various time points after treatment（ P〈0. 01）. Postoperative follow-up at 180 days after treatment showed that the excellent rates and effective rates of Group A were： 87. 39% and96. 63% and Group B were 23. 89% and 47. 79%,respectively. After operation,the area of the posterior branch of spinal nerve in the postoperative period and skin shallow feeling slightly decreased in 13 patients,with incidence rate at17. 57%. Conclusion： CT Guided Looper Radiofrequency Percutation for the Treatment of Cervical Axial Pain of Cervical Dorsal Rami has some advantages including precise location,good safety,high and quick efficacy,and few complications.