高电压长时程脉冲射频治疗腰椎术后神经痛的疗效分析

Efficacy of high‐voltage long‐duration pulsed radiofrequency treatment in patients with neuralgia resulting from failed back surgery syndrome

目的探讨高电压长时程脉冲射频(PRF)治疗腰椎术后下肢神经痛的有效性及安全性。方法回顾性分析2017年1月至2020年1月在北京大学第三医院疼痛科住院手术的58例腰椎术后下肢神经痛患者的临床资料。根据其治疗方式分为两组:对照组(n=30):超声及X线引导下在患侧腰椎脊神经给予标准脉冲射频治疗;试验组(n=28):超声及X线引导下在患侧腰椎脊神经给予高电压长时程脉冲射频治疗。记录所有患者治疗前及术后1周、1个月、6个月的疼痛视觉模拟评分(VAS)、Oswestry功能障碍指数(ODI)、生活质量评分(SF‑36)、抑郁量表评分(PHQ‑9)、并发症及术后不良反应的发生情况。结果两组患者术后各时间点VAS、ODI、SF‑36及PHQ‑9评分均较术前明显降低(均P<0.01);在术后1个月内,两组患者间的VAS、ODI、PHQ‑9差异无统计学意义(P>0.05),术后6个月时试验组低于对照组(P<0.05);术后6个月时试验组显效率、总有效率分别为78.6%(22/28)、92.9%(26/28),高于对照组的60.0%(18/30)、83.3%(25/30),但差异无统计学意义(均P>0.05);两组患者在整个治疗过程中均无严重并发症发生。结论两种治疗方案均可有效缓解腰椎术后下肢神经痛。高电压长时程脉冲射频较标准脉冲射频效果更好,持续时间更长。

Objective To explore the efficacy and safety of high-voltage long-duration pulsed radiofrequency(PRF)treatment in patients with neuralgia resulting from failed back surgery syndrome(FBSS).Methods The clinical data of 58 patients diagnosed with neuralgia resulting from FBSS in the Department of Pain Medicine,Peking University Third Hospital from January 2017 to January 2020 were retrospectively analyzed.The patients were divided into two groups according to the treatment method.Experimental group(n=28)underwent high-voltage long-duration PRF therapy,using ultrasound and X-ray guidance to target the spinal nerve of the affected side,while control group(n=30)was applied with the standard pulsed radiofrequency therapy.Visual analogue scale(VAS),Oswestry disability index(ODI),36-item short form health survey(SF-36),patient health questionnaire(PHQ-9)before treatment and at 1 week,1 month,and 6 months after treatment were recorded.Meanwhile,postprocedural complications and adverse reactions were also collected.Results VAS,ODI,SF-36 and PHQ-9 scores at 1 week,1 month,and 6 months after treatment were significantly improved in both groups compared with their respective pre-treatment baseline scores(all P<0.01).The differences of VAS,ODI,and PHQ-9 scores between the two groups were not statistically significant at 1 month after treatment(all P>0.05).However,VAS,ODI,and PHQ-9 scores were lower in experiment group than those in control group at 6 months after treatment(all P<0.05).The marked improvement rate and total effective rate at 6 months after treatment in experiment group was 78.6%(22/28)and 92.9%(26/28),respectively,which were higher than that of control group[60.0%(18/30)and 83.3%(25/30),respectively],but the differences were not statistically significant(both P>0.05).No serious complications occurred during the whole period of treatment.Conclusions Both treatments can effectively relieve the lower limb neuralgia.High-voltage long-term PRF has better efficacy and longer duration than standard PRF.