不同靶位脉冲射频治疗老年胸背部带状疱疹后神经痛临床疗效比较

CLINICAL EFFICACY OF PULSED RADIOFREQUENCY ON TWO DIFFERENT TARGET REGIONS TO TREAT THORACIC POSTHERPETIC NEURALGIA IN AGED PEOPLE

目的:比较背根神经节(dorsal root ganglion,DRG)脉冲射频与脊神经前支联合后支脉冲射频治疗老年胸背部带状疱疹后神经痛(postherpetic neuralgia,PHN)的临床疗效。方法:40例老年胸背部PHN病人,随机分为两组:A组(n=20)为胸DRG脉冲射频组,B组(n=20)为胸神经前支+后支脉冲射频组。治疗前所有病人视觉模拟评分(visual analogue scale,VAS)。于首次治疗后第24 h,三次治疗后第24 h和出院后的1周、1月、3月、6月进行VAS评分,记录曲马多和加巴喷丁的摄取人数。治疗前、出院后1月、3月、6月进行匹兹堡睡眠质量指数(pittsburgh sleep quality index,PSQI)、SF-36、焦虑、抑郁评分。比较上述两组各指标改善情况。结果:治疗后,两组VAS、PSQI总分、焦虑、抑郁评分均较治疗前明显下降,而SF-36总分升高(P<0.05)。首次脉冲射频(pulsed radiofrequency,PRF)后第24 h,A组VAS和曲马多摄取率均小于B组(P<0.05)。三次治疗后各同时点A、B两组比较,VAS评分、PSQI总分、SF-36总分、焦虑、抑郁评分未见显著性差异(P<0.05),但曲马多摄取率比较,A组小于B组(P<0.05)。结论:胸DRG脉冲射频与脊神经前支+后支脉冲射频均可有效治疗老年PHN,但前者优于后者。

Objective:To compare the efficacy of pulsed radiofrequency(PRF)between dorsal root ganglion(DRG)and anterior branch combined with posterior branch of thoracic nerve for treatment of postherpeticneuralgia(PHN)in aged people.Methods:Forty patients with thoracic PHN were enrolled and randomlydivided into two groups:group A(n=20):pulsed radiofrequency applied on DRG of the required segment;group B(n=20):pulsed radiofrequency applied on the anterior branch combined with posterior branch ofthoracic nerve at the segment required.The visual analogue scale(VAS)was observed at pre-treatment,24hours after the first PRF,24hours after the third PRF,and1week,1month,3months and6months ofpost-treatment.The number of patients received tramadol and gabapentin were recorded at24hours afterthe first PRF,24hours after the third PRF,and1week,1month,3months and6months of post-treatment.The Pittsburgh sleep quality index(PSQI),SF-36,hospital anxiety and depression scale were calculated atpre-treatment,and1month,3months and6months of post-treatment in all patients.Results:Comparedwith pre-treatment,the scores of VAS,PSQI,anxiety and depression were significantly decreased,whereasthe SF-36was improved after PRF treatment in both groups(P<0.05).At24hours after the first PRF,the reduction in VAS and number of received tramadol in group A were compared with group B(P<0.05).The scores of VAS,PSQI,SF-36,anxiety and depression in group A were no superior to those in group B.However,the ratios of tramadol taken orally in group A were lower than those in group B at24hours after thethird PRF,and1week,1month,3months and6months of post-treatment(P<0.05).Conclusions:Pulsedradiofrequency on DRG or the anterior branch combined with posterior branch of thoracic spinal nerve is aneffective treatment for PHN in aged people.However,the former PRF gains an advantage over the latter.