脊神经后支联合局部痛点射频热凝治疗老年骨质疏松性椎体压缩性骨折患者腰背痛的疗效

Efficacy of radiofrequency thermocoagulation at spinal nerve posterior branch and local pain points in the treatment of elderly patients with chronic low back pain caused by osteoporosis vertebra compressed fracture

目的观察脊神经后支射频热凝联合痛点射频热凝治疗老年骨质疏松性椎体压缩性骨折性腰背痛患者的疗效。方法收集2014年3月至2017年10月就诊于中国人民解放军陆军第八十一集团军医院(原解放军第二五一医院)的老年骨质疏松性椎体压缩性骨折性腰背痛患者60例,男19例,女41例,年龄67~82岁,按照随机数字表法将其分为脊神经后支射频组(SR组)和脊神经后支射频联合局部痛点射频组(TSR组),每组30例。SR组患者确定目标椎体并定位后在数字减影血管造影(DSA)引导下穿刺到位后行连续射频,温度65、70、75℃各2min。同样操作完成目标椎体上位及下位脊神经后支射频热凝。TSR组采用脊神经后支联合局部痛点射频热凝治疗,脊神经后支射频完毕后行痛点射频热凝,于病椎及上、下一个节段范围内找到压痛点,根据疼痛轻重、范围大小确定穿刺点,每点给予连续射频,温度70℃,时间1min。比较两组治疗后1、7d及治疗后1、3、6个月时视觉模拟评分(VAS)、Oswestry功能障碍指数问卷评分(ODI)及不良反应。结果与治疗前比较,治疗后两组患者VAS评分均降低(P<0.05),治疗后1、3、6个月时TSR组患者较SR组降低更明显[(3.4±0.6)比(2.9±1.2)、(2.9±0.8)比(1.6±0.4)、(2.7±1.3)比(0.9±0.4),P<0.05]。与治疗前比较,治疗后TSR组患者ODI评分均降低,且小于SR组(P<0.05)。治疗后1、3、6个月时SR组患者VAS、ODI评分组内比较差异无统计学意义(P>0.05),TSR组患者评分组内比较差异有统计学意义(P<0.05)。结论脊神经后支射频热凝联合局部痛点射频热凝治疗老年骨质疏松性椎体压缩性骨折性腰背痛患者疗效确切,效果优于单纯脊神经后支射频热凝治疗,且远期疗效更优。

Objective To observe the efficacy of radiofrequency thermocoagulation at spinal nerve posterior branch and local pain points in the treatment of elderly patients with chronic low back pain caused by osteoporosis vertebra compressed fracture. Methods Sixty patients with chronic low back pain caused by osteoporosis vertebra compressed fracture, from March 2014 to October 2017 in the 81st Group Army Hospital of the PLA Army (the original 251st Hospital of PLA), 19 males and 41 females, aged 67-82 years, were randomly divided into SR group and TSR group, 30 cases in each group. The patients received radiofrequency thermocoagulation at superior and inferior spinal nerve posterior branch in SR group. The target vertebral body was determined firstly, then puncture under DSA guidance followed by radiofrequency at the temperature of 65, 70, 75 ℃ for 2 min respectively. Radiofrequency at spinal nerve posterior branch was the same as mentioned above, while patients also received pain points radiofrequency at the temperature of 70 ℃ for 1 min in TSR group. The local pain points were determined by the intensity and pain area over the painful vertebral and fluctuation area. VAS and ODI were recorded at 1 day, 7 days, 1 month, 3 months and 6 months after the treatment. Results Compared with pre-treatment, VAS was decreased at each time point after the treatment in two groups (P<0.05), especially in TSR group at 1, 3, 6 months[(3.4±0.6) vs.(2.9±1.2),(2.9±0.8) vs.(1.6±0.4),(2.7±1.3) vs.(0.9±0.4), P<0.05]. ODI was decreased at each time point after the treatment in each group (P<0.05), especially in TSR group (P<0.05). No difference was found in VAS and ODI in SR group of spinal nerve posterior branch, while there was significant difference in TSR group at 1, 3, 6 months after the treatment (P>0.05). Conclusion Radiofrequency thermocoagulation at spinal nerve posterior branch and local pain points is an effective method in elderly patients with chronic low back pain caused by osteoporosis vertebra compressed fracture, and the long-efficacy is better than posterior branch of spinal nerve radiofrequency only.