椎间孔镜直视下脊神经后内侧支射频消融术治疗小关节源性腰痛

Radiofrequency ablation of the medial dorsal branch of the spinal nerve under intervertebral foramen for the treatment of facet joint low back pain

目的探讨小关节源性腰痛的治疗方法,对比药物保守治疗与椎间孔镜下脊神经后内侧支射频消融术的临床疗效。方法自2014-08-2016-08收治小关节源性腰痛患者97例,依据治疗方案的不同分为两组:保守组54例,均口服非甾体类药物治疗;射频组43例,予以经皮椎间孔镜下脊神经后内侧支射频消融术治疗。两组患者治疗后均随访12个月,对比其临床疗效。结果 (1)射频组患者在治疗后1、3、12个月,其VAS评分均显著低于治疗前,JOA评分显著高于治疗前(均为P<0.05);保守组治疗后1个月时,其两项指标亦有显著改善(P<0.05),但其后,至3个月时疗效显著下降,12个月时进一步下降。治疗后1、3、12个月,射频组的两项指标改善情况均显著优于保守组,差异均有统计学意义(P<0.05)。(2)治疗后1年时,射频组优良率为90.70%,显著高于对照组的35.19%,差异有统计学意义(P<0.05)。结论相较于传统口服非甾体类药物而言,椎间孔镜下脊神经后内侧支射频消融术治疗小关节源性腰痛的改善效果更佳,且疗效更加稳定。

Objective To investigate the treatment of low back pain caused by small joint, andcompare the clinical efficacy of conservative treatment and transforaminal endoscopic radiofrequency（RF） ablation of the medial branch of the spinal nerve. Methods From August 2014 to August 2016,97 patients with low back pain caused by small joints were treated. According to different treatmentoptions, they were divided into two groups： 54 patients in the conservative group were treated with nonsteroidal drugs, radiofrequency catheter ablation of the medial posterior branch of the spinal nerve wasperformed in 43 patients in the RF group. The patients in the two groups were followed up for 12months after treatment, and the clinical efficacy was compared. Results ①After treatment for 1, 3,12 months, the VAS scores of RF group were significantly lower than before treatment, the JOA scorewas significantly higher than before treatment （P〈0.05）. After treatment for 1 month, the two indicatorsin the conservative group were improved significantly （P〈0.05）, but then, the effect was significantlydecreased at 3 months, 12 months to decline further. At 1, 3 and 12 months after treatment, theimprovement of the two indicators in the RF group were significantly better than those in theconservative group, and the differences were statistically significant （P 〈0.05）. ②After 1 year oftreatment, the excellent and good rate of RF group was 90.70%, which was significantly higher than35.19% of the control group, the difference was statistically significant （P 〈0.05）. ConclusionCompared with the traditional oral non steroidal drugs, the radiofrequency ablation of the medialbranch of the posterior ramus of the lumbar spine under the transforaminal endoscope is more effectiveand more stable in the treatment of facet joint low back pain.