腰椎间盘低温等离子消融联合腰交感神经导管置入治疗盘源性内脏痛的效果

Therapeutic effect of low temperature plasma ablation in conjunction with lumbar sympathetic nerve catheterization on the lumbar discogenic visceral pain

目的探讨腰椎间盘低温等离子消融联合腰交感神经导管置入治疗盘源性内脏痛的效果。方法回顾性分析2015年1月~2017年1月首都医科大学宣武医院腰椎间盘源性内脏痛患者34例,其中18例采用单纯腰交感神经导管置入法治疗,为A组;16例采用腰椎间盘低温等离子消融联合腰交感神经导管置入法治疗,为B组。记录两组术前及术后即刻,1周,3、6、12个月的疼痛数字分级评分(NRS);比较两组术前及术后12个月抑郁自评量表评分(SDS);分析两组术前及术后即刻,1周,3、6、12个月的NRS差值和两组术前,术后12个月的SDS评分及差值。NRS差值=术前NRS-术后NRS,SDS差值=术前SDS-术后SDS。观察两组不良反应以及并发症发生情况。结果 B组术后3、6、12个月的NRS差值均大于A组,差异均有统计学意义(P=0.001、0.001、0.011)。两组术前SDS评分差异无统计学意义(P=0.397);A组术后12个月SDS评分与术前比较,差异无统计学意义(P=0.974);B组术后12个月SDS评分与术前比较,差异有高度统计学意义(P=0.001)。B组术后12个月SDS差值高于A组,差异有统计学意义(P=0.010)。两组均无感染及神经损伤导致支配区域异感、麻木等并发症发生。结论腰椎间盘低温等离子消融联合腰交感神经导管置入法相对于单纯腰交感神经导管置入治疗腰椎间盘源性内脏痛,中远期疗效更佳,且可以缓解抑郁。

Objective To discuss the therapeutic effect of low temperature plasma ablation in conjunction with lumbar sympathetic nerve catheterization on the lumbar discogenic visceral pain. Methods Thirty-four patients with lumbar discogenic visceral pain who were treated in the Xuanwu Hospital, Capital Medical University from January 2015 to January 2017 were divided into two groups. Eighteen patients treated with the lumbar sympathetic nerve catheterization were included into Group A, and 16 patients treated with the low temperature plasma ablation in conjunction with lumbar sympathetic nerve catheterization were included into Group B. The numeric rating scales （NRS） depending on the level of pain of two groups before surgery and different periods after surgery （immediately, 1 week, 3, 6 and 12 months） were recorded. The self-rating depression scale （SDS） of two groups before and 12 months after surgery were contrasted. The NRS differentials of two groups before surgery and immediately, 1 week, 3, 6, 12 months after surgery and the SDS scores and differentials of two groups before and 12 months after surgery were analyzed. The NRS/SDS differentials were the NRS/SDS before surgery minus the NRS/SDS after surgery. Adverse reaction and complication after surgery were recorded. Results The NRS differential of 3, 6, 12 months after surgery of Group B were higher than those of Group A, the differences were statistically significant （P = 0.001, 0.001, 0.011）. The SDS scores of two groups before surgery showed no statistical significance （P = 0.397）. The SDS scores of Group A before and 12 months after surgery showed no statistical significance （P = 0.974）.And the SDS scores of Group B before and 12 months after surgery showed statistical significance （P = 0.001）. The SDS differential of 12 months after surgery of Group B was higher than that of Group A with statistical significance （P = 0.010）. The two groups exhibited no complication such as paresthesia or numbness in corresponding dominating region caused by infection and nerve injury. Conclusion Compared with single lumbar sympathetic nerve catheteriza- tion, the low temperature plasma ablation in conjunction with lumbar sympathetic nerve catheterization exhibits a better effect in mid-long-term on lumbar discogenic visceral pain, and can relieve the depression.