超声引导下经坐骨棘入路脉冲射频治疗阴部神经痛的临床研究

Therapeutic efficacy of ultrasound-guided radiotherapy at ischial spine for pudendal neuralgia

目的评估超声引导下经坐骨棘入路阴部神经阻滞成功率和脉冲射频治疗阴部神经痛（pudendal neuralgia，PN）的有效性。方法采用Nantes诊断标准，共人组20例诊断为PN的患者，其中男性6例，女性14例，年龄42～68岁（平均年龄57岁），在超声引导下采用坐骨棘人路经皮穿刺至阴部内动脉附近，在感觉及运动测试覆盖治疗靶区满意后行脉冲射频治疗。通过门诊或电话随访，评定患者疼痛和生活质量改善情况。结果共18例患者完成随访，18例患者中有16例患者在脉冲射频治疗7d后疼痛（VAS评分）明显改善（P〈0．05），并且疗效稳定持续至治疗后6个月，且这些患者在治疗后7、14d的坐位持续时间明显延长（P〈0．05），而治疗后7d与治疗后14d的坐位持续时间差异无统计学意义（P〉0．05）。结论超声引导下的脉冲射频治疗PN是一种简便、安全且有效的治疗方式。

Objective To explore the therapeutic efficacy of ultrasound-guided pulse-dose radiofrequency at the ischial spine for pudendal neuralgia （PN）. Methods Twenty patients （6 males and 14 females）, aged 42 to 68 years, were diagnosed as PN according to Nantes criteria. For the treatment of PN, a pulse-dose radiofrequency needle was guided by ultrasound to locate at the ischial spine, lateral to the internal pudendal artery and the pudendal nerve at the transverse section. The position of pulse-dose radiofrequency needle was optimized by its stimulation of the sensory and motor responses in the pudendal area. Postoperative pain symptoms and life quality of the patients were followed up. Results Eighteen out of 20 patients completed the study. The mean VAS scores were significantly improved after 7 days＇ pulse-dose radiofrequency （P〈0.05）, and the effect lasted for at least 6 months. The pain-free sitting time was significantly increased 7 and 14 days after pulse.dose radiofrequency （P〈0.05）. Conclusions Ultrasoundguided pulse.dose radiofrequency is a safe and effective technique to treat PN.