椎间孔镜下脊神经后内侧支射频消融术治疗腰椎关节突关节源性腰痛的疗效

Clinical therapeutic effect of spinal nerve medial branch ablation through transforaminal endoscopic in treatment of lumbar zygapophysial joint pain

目的:探讨椎间孔镜下脊神经后内侧支射频消融治疗关节突关节源性腰痛的临床疗效。方法:分析2008年8月至2013年10月收治的关节突关节源性腰痛患者96例,其中保守治疗60例,椎间孔镜下脊神经后内侧支射频消融术治疗36例。随访治疗前,治疗后1、3、6及12个月患者腰椎视觉模拟评分(VAS)、改良日本骨科学会治疗评分(JOA),12个月随访腰椎改良Mac Nab功能评分。结果:手术治疗组术后各时间点VAS、JOA评分与术前相比均明显改善(P<0.05),术后各时间点之间差异无统计学意义。保守治疗组治疗后1个月VAS、JOA评分较治疗前明显改善(P<0.05),后期较治疗前差异无统计学意义。手术治疗组术后各时间点VAS、JOA评分均优于保守治疗组(P<0.05)。12个月改良Mac Nab功能评分手术治疗组优良率(94.44%)明显高于保守治疗组(33.33%)。结论:椎间孔镜下脊神经后内侧支消融术是一种安全有效治疗腰椎关节突源性腰痛的微创脊柱外科技术,具有重要临床应用价值。

Objective To investigate the clinical value and effect of spinal nerve medial branch ablation through transforaminal endoscopic in treatment of lumbar zygapophysial joint pain. Methods From August 2008 to October 2013, 96 patients diagnosed as lumbar zygapophysial joint pain were included in the research. 36 patients were treated by spinal nerve medial branch ablation through transforaminal endoscopic, while 60 patients received conservative treatment. The visual analogue scale （VAS） and Japanese Orthopedics Association （JOA） scores before treatment, 1,3,6 and 12 months after treatment were recorded and analyzed. The MaeNab scores were recorded and analyzed 12 months after treatment. Results The VAS and JOA scores of surgical treatment group showed significant improvement compared with that before operation （P 〈 0.05 ） , and there were no significant difference at each time point after surgery. The VAS and JOA scores of conservative treatment group in showed significant improved at 1 months after treatment compared with that before treatment （P 〈 0.05 ）, but there were no significant difference at each time after treatment compared with pretreatment. The VAS and JOA scores of surgical treatment group showed significant improvement compared with conservative treatment group at each time after treatment （P 〈 0.05）. The MacNab scores of surgical treatment group （94.44%） was significantly higher than that of conservative treatment group （33.33%）. Conclusion The spinal nerve branches ablation under transforaminal endoscopic is an effective and safe minimally invasive spine surgery technique with important clinical value in the treatment of lumbar zygapophysial joint pain.