超声引导下C_(2)神经根阻滞联合冲击波治疗颈源性头痛的临床研究

Clinical study of ultrasound-guided C_(2) nerve root block combined with shock wave in treatment of cervicogenic headache

目的观察超声引导下C_(2)神经根阻滞联合冲击波治疗颈源性头痛(CEH)的临床疗效。方法选择60例CEH患者,其中男性27例,女性33例;年龄35~60岁,平均年龄47.82岁;病程4~15年,平均病程10.03年;疼痛视觉模拟(VAS)评分4~9分,平均VAS评分7.62分。随机分为2组,30例予以单纯超声引导下C_(2)神经根阻滞治疗(单纯组),30例予以超声引导下C_(2)神经根阻滞联合冲击波治疗(联合组)。评估两组治疗前及术后1周、1个月、3个月、6个月时VAS评分,并采用Macnab疗效评定标准于术后各时间点进行优良率评定。同时观察治疗期间并发症发生情况。结果相比于治疗前,两组术后各时间点VAS评分均明显降低(P均<0.05);联合组术后3个月、6个月VAS评分均明显低于单纯组[3个月:(1.84±0.66)分vs (3.06±0.91)分;P <0.05。6个月:(1.98±0.63)分vs (3.61±1.13)分;P <0.05]。两组术后1周、1个月、3个月疗效优良率对比,差异均无统计学意义(P> 0.05),而联合组术后6个月优良率明显高于单纯组(80.00%vs 53.33%;P <0.05)。两组均未出现感染、脑脊液漏、脑卒中严重并发症。结论超声引导下C_(2)神经根阻滞联合冲击波治疗CEH,远期疗效优于单纯C_(2)神经根阻滞。

Objective To observe the clinical efficacy of ultrasound-guided C_(2) nerve root block combined with shock wave in treatment of cervicogenic headache(CEH). Methods A total of 60 patients with CEH were enrolled, which included 27 males and 33 females, aged 35-60 years old with mean age of 47.82 years old;duration 4-15 years with mean duration of 10.03 years;pain visual analogue scale(VAS) score was 4-9 scores with mean VAS score 7.62 scores. All of them were divided into simple group(n = 30, performed ultrasound-guided C_(2) nerve root block therapy) and combined group(n = 30, performed ultrasound-guided C_(2) nerve root block combined with shock wave therapy). The VAS scores before treatment and 1-week, 1-month, 3-month and 6-month post operation were evaluated and recorded, superior rate at each time point were evaluated by Macnab efficacy evaluation criteria. Meanwhile, complications during treatment were observed. Results The VAS scores of each time point post operation in 2 groups were lower than those of before treatment(P < 0.05). VAS scores of 3-month and 6-month post operation in combined group were significantly lower than those in simple group[3-month:(1.84 ± 0.66) scores vs(3.06 ±0.91) scores;P < 0.05. 6-month:(1.98 ± 0.63) scores vs(3.61 ± 1.13) scores;P < 0.05]. There was no significant difference in efficacy superior rate at 1-week, 1-month, and 3-month post operation between 2 groups(P > 0.05), but superior rate at 6-month after operation in combined group was significantly higher than that in simple group(80.00 % vs 53.33 %;P < 0.05). There were no serious complications such as infection, leakage of cerebrospinal fluid and stroke in 2 groups. Conclusion It is demonstrated that ultrasound-guided C_(2) nerve root block combined with shock wave in treatment of CEH showed better longterm efficacy than simple C_(2) nerve root block.