超声与CT引导下胸椎椎间孔注射治疗老年带状疱疹后神经痛的对比研究

COMPARATIVE STUDY OF ULTRASOUND-GUIDED AND CT-GUIDED THORACIC INTERVERTEBRAL FORAMEN INJECTION ON ELDER PATIENTS WITH POSTHERPETIC NEURALGIA

目的:观察超声与CT引导下胸椎椎间孔注射治疗老年带状疱疹后神经痛(postherpetic neuralgia,PHN)的疗效及安全性。方法:选择90例老年胸段带状疱疹后神经痛病人按治疗方法不同随机分为对照组、CT组和超声组,每组30例;对照组采用口服药物镇痛(加巴喷丁);CT组采用CT引导下行胸椎椎间孔注射治疗联合口服药物;超声组采用超声引导下行胸椎椎间孔注射治疗联合口服药物;随访3个月,比较三组病人治疗前、后各个随访时间的疼痛视觉模拟评分(visual analogue scale,VAS)、睡眠质量评分(quality of sleep,QS),口服加巴喷丁用量,以及不良反应发生情况。结果:治疗前,三组病人VAS及QS评分无显著差异,治疗后与对照组比较,超声组及CT组各随访时间段VAS及QS评分均低于对照组(P<0.05),口服加巴喷丁的用量以及不良反应的发生率低于对照组(P<0.05);而超声组与CT组比较,各时间段VAS及QS评分,口服加巴喷丁用量及不良反应的发生率无显著差异。结论:超声及CT引导下胸椎椎间孔注射治疗对老年带状疱疹后神经痛疗效确切,而超声引导可以达到CT引导相同的效果,基于超声无辐射、价廉等优势,值得临床上推广。

Objective:To observe the efficacy and safety of ultrasound-guided and CT-guided thoracic intervertebral foramen injection on elder patients with postherpetic neuralgia.Methods:Ninety patients aged≥60 year old with Thoracic postherpetic neuralgia were randomly divided into control group,CT group and ultrasound group,30 cases in each group.Control group received oral drug analgesia(gabapentin);CT group received oral drug combined with thoracic intervertebral foramen injection under CT-guided;ultrasound group received oral drug combined with thoracic intervertebral foramen injection under ultrasound-guided.Patients in three groups were compared with visual analogue scale(VAS)and sleep quality score(QS)at the time of before treatment,and 1,2,4,12 weeks of post-treatment.The doses of gabapentin and side effects were also recorded.Results:Before treatment,there were no significant differences in VAS and QS scores among the three groups.The VAS and QS scores of CT group and ultrasound group decreased significantly at any time of post-treatment compared with control group(P<0.05).The doses of gabapentin in CT group and ultrasound group were significantly lower than that in control group C(P<0.05).The side effects was lower than that of the control group(P<0.05).However,there was no significant difference in the VAS,QS scores,oral gabapentin dosage and side effects between the ultrasound group and the CT group(P>0.05).Conclusion:Ultrasound-guided and CT-guided thoracic intervertebral foramen injection effectively alleviates pain in old patients with postherpetic neuralgia,improve sleep,reduce the dosage of medication,with high safety;ultrasound guidance can achieve the same effect of CT guidance,based on radiation-free,low price and other advantages,it is worthy clinical promotion.