不同病程腰椎间盘突出症经CT引导下选择性神经根阻滞结合脉冲射频治疗的临床观察

Clinical observation of selective lumbar nerve root block combined with pulsed radiofrequency therapy under CT guidance in the treatment of lumbar disc herniation with different courses

目的探讨不同病程的腰椎间盘突出症患者,采用CT引导下选择性神经根阻滞(SNRB)联合脉冲射频治疗的临床疗效是否有所差异。方法回顾性分析2013-04-2015-04采用CT引导下SNRB联合脉冲射频治疗的121例LDH患者,依据其病程的不同,将其分为3组:病程<3个月者27例(A组),3-12个月41例(B组),>12个月53例(C组)。对3组患者治疗前、治疗后1个月、3个月和12个月的VAS评分,以及治疗后12个月的临床疗效进行组间对比。结果 3组患者治疗后,其VAS评分均有显著性降低(P<0.05),且治疗后12个月与1、3个月时相比,均未见显著升高(P>0.05);但A组患者术后1、3、12个月的VAS评分均显著低于B、C两组(P<0.05)。术后12个月时,A组的总有效率达到85.2%,明显高于B组的75.6%和C组的71.7%,差异均有统计学意义(P<0.05)。结论 CT引导下SNRB联合脉冲射频可显著改善患者腰腿痛,病程在3个月以内的急性期患者可取得更好的疗效。

Objective To investigate the clinical efficacy of CT guided selective nerve root block（SNRB） combined with pulsed radiofrequency in the treatment of lumbar disc herniation （LDH） withdifferent course of disease. Methods From April 2013 to April 2015, the clinical data of 121 LDHpatients who received CT guided SNRB combined with pulsed radiofrequency treatment wereretrospectively analyzed. According to the different duration, the patients were divided into 3 groups：27 patients 〈3 months （A group）, 3-12 months in 41 cases （B group）, 〉12 months in 53 cases （groupC）. The VAS scores of the 3 groups before treatment, 1 month, 3 months and 12 months aftertreatment, as well as the clinical efficacy after 12 months were compared among the three groups.Results The scores of VAS were significantly lower in the 3 groups after treatment （P〈0.05）, andthere was no significant increase at 12 months after treatment compared with postoperative 1 and 3months （P 〉0.05）. But the VAS scores of A group at 1, 3 and 12 months after operation weresignificantly lower than those in group B and group C （P 〈0.05）, but there was no statisticallysignificant difference between group B and group C （P〉0.05）. At 12 months after operation, the totaleffective rate of A group was 85.2%, which was significantly higher than 71.7% of group B and 75.6%of group C, and the difference was statistically significant （P〈0.05）. Conclusion CT guided SNRBcombined with pulsed radiofrequency can significantly improve the patients with low back pain, thecourse of disease within 3 months of the acute phaseof patients can achieve better results.