脊神经后支射频热凝联合经皮髓核减压术治疗椎间盘源性下腰痛的疗效观察

Curative effect of posterior spinal radiofrequency thermocoagulation combined with percutaneous decompression of nucleus pulposus in treatment of discogenic low back pain

目的探讨脊神经后支射频热凝联合髓核减压术治疗椎间盘源性下腰痛(discogenic low back pain,DLBP)的临床疗效。方法自2014-01-2015-09,共纳入80例DLBP患者,分别采用单纯的经皮髓核减压术治疗39例(减压组)、髓核减压术联合脊神经后支射频热凝术治疗41例(联合组),对两组患者治疗前、治疗后3 d、3个月和1年时,分别采用疼痛VAS评分和JOA评分进行评价;并于术后平均21.3个月的末次随访时,利用MacNab分级标准进行疗效评定。结果两组患者术后JOA评分与VAS评分均有显著改善(P<0.05),但联合组上述指标在术后3 d、3个月和1年时,均有更好的改善效果(P<0.05);联合组总有效率为92.7%,也显著高于对照组的82.1%(P<0.05)。结论在微创髓核减压手术的基础上联合脊神经后支射频热凝术治疗DLBP,术后较长时间内可更好地缓解疼痛、恢复腰椎功能,其疗效可靠,不失为一项有效的治疗方案。

Objective To investigate the clinical efficacy of posterior spinal radiofrequency thermocoagulation combined with nucleus pulposus decompression in the treatment of discogenic lowback pain（DLBP）. Methods From January 2014 to September 2015, a total of 80 patients with DLBP were enrolled. Simple percutaneous nucleus decompression was performed in 39 cases（ decompression group）, nucleus pulposus decompression combined with posterior spinal nerve radiofrequency thermocoagulation was performed in 41 cases （ combined group）. The VAS and JOA scores at 3d, 3months and 1 year after treatment were observed. And after the average follow-up of 21.3 months atthe end of the operation, the MacNab grading standard was used to evaluate the effect. Results TheJOA scores and VAS scores of the two groups were significantly improved（ P〈0.05）,and the combined group had better improvement effect at 3d, 3 months and 1 year after operation （ P〈0.05）. The total effective rate of the combined group was 92.7%, which was significantly higher than 82.1% of the control group（ P〈0.05）. Conclusion On the basis of minimally invasive surgical decompression of nucleus pulposus, the combination of posterior branch of spinal nerve radiofrequency thermocoagulation in the treatment of DLBP, can better relieve pain and restore lumbar function, itscurative effect is reliable, can be used as an effective treatment plan.