经皮脊神经后内侧支毁损术治疗慢性关节突关节源性腰痛

CLINICAL OBSERVATION OF PERCUTANEOUS ABLATION OF MEDIAL BRANCH OF POSTERIOR LUMBAR RAMUS FOR THE TREATMENT OF CHRONIC LUMBAR ZYGAPOPHYSEAL JOINT ORIGINATED PAIN

目的:观察经皮脊神经后内侧支毁损术治疗慢性关节突关节源性腰痛的临床疗效,探讨其应用的安全性及有效性。方法:2015年8月至2017年5月,收治慢性腰痛病人76例,所有病人均经对照性诊断阻滞确诊为关节突关节源性腰痛。根据病人选择及知情同意,42例经皮脊神经后内侧支毁损术治疗(射频组),34例采用保守治疗(对照组)。病人评价治疗前后视觉模拟评分(visual analogue scale, VAS)、腰椎Oswestry功能障碍指数(oswestry disability index, ODI)及病人满意度(patient Satisfaction Index, PSI),并行腰椎动力位X线检查,观察腰椎活动度(range of motion, ROM)的变化情况。所有病人接受6～30个月的随访。结果:治疗后4周、12周及末次随访时,对照组VAS评分、ODI指数和腰椎整体ROM与治疗后2周有显著差异(P <0.05)。治疗2周后各时间点,射频组VAS评分、ODI指数明显低于对照组,腰椎整体ROM则明显高于对照组,各指标均明显优于治疗前(P <0.05),与治疗后2周无显著差异。结论:经皮脊神经后内侧支毁损术是治疗慢性关节突关节源性腰痛安全、有效的方法,疗效优于传统保守治疗方法。

Objective:To investigate the early clinical and radiological outcome and evaluate the safety and efficiency of percutaneous ablation of dorsal ramus branches to treat chronic lumbar zygapophyseal joint originated pain.Methods:From August 2015 to May 2017,76 patients with chronic low back pain were diagnosed as chronic lumbar zygapophyseal joint originated pain after controlled differential(double)medial branch block(MBB).According to the patient's choice and informed consent,42 cases underwent percutaneous ablation of medial branch of posterior lumbar ramus(group A),while 34 cases underwent conservative treatment,including NSAIDs,physical therapy and recognition therapy(group B).The clinical evaluation included visual analogue scale(VAS),Oswestry disability index(ODI),and patient satisfaction index(PSI)at pre-operation and final follow-up.Radiographic evaluation included range of lumbar motion(ROM)in the flexion/extension lateral view.All cases were followed up 15.6 months on average(6-30 months).Results:The VAS score,ODI score and lumbar ROM were significantly improved in group B at 4 and 12 weeks and final follow-up compared with those at 2 weeks after treatment(P<0.05)and were similar with before treatment(P >0.05).The VAS score,ODI score and lumbar ROM at each time point of post-treatment 2 weeks were significantly improved in group A compared with those in group B(P<0.05)and had no significant difference with those at 2 weeks after treatment(P >0.05).Conclusion:This study shows that percutaneous ablation of medial branch of posterior lumbar ramus is a more effective procedure than conservative treatment for the treatment of chronic lumbar zygapophyseal joint originated pain