背根神经节恒定感觉刺激电压下延长脉冲射频作用时间治疗神经根性颈椎病的有效性及安全性评价

Evaluation of the efficacy and safety of prolonging the action time of pulsed radiofrequency under constant sensory stimulation voltage of dorsal root ganglion in the treatment of radiculopathy of cervical spondylosis

目的评价背根神经节恒定感觉刺激电压下延长脉冲射频作用时间治疗神经根性颈椎病的有效性及安全性。方法选择2016年5月—2019年8月华中科技大学同济医学院附属协和医院诊治的神经根性颈椎病患者121例,随机分为8 min脉冲射频组、10 min脉冲射频组、12 min脉冲射频组,每组刺激电压均为0.3 V,脉冲射频作用时间分别为8 min、10 min、12 min。记录3组患者术前及术后1 d、7 d、14 d、30 d、60 d、90 d的VAS评分,根据Odom分级评估3组术后1 d、30 d、90 d的优良率,同时记录3组并发症发生情况。结果最终完成研究者90例,每组30例。3组术后各时间点VAS评分均显著低于术前(P均<0.05),但3组间术后1 d、7 d、14 d、30 d、60 d的VAS评分比较差异均无统计学意义(P均>0.05);12 min脉冲射频组术后90 d的VAS评分明显低于8 min脉冲射频组和10 min脉冲射频组(P均<0.05)。3组术后1 d、30 d的优良率比较差异均无统计学意义(P均>0.05),12 min脉冲射频组术后90 d的优良率明显高于8 min脉冲射频组和10 min脉冲射频组(P均<0.05)。3组均无短暂的疼痛加重、感觉障碍及肌力变化,8 min脉冲射频组、10 min脉冲射频组均无明显麻木及无力感;12 min脉冲射频组患者均有麻木感,均在1周内恢复。结论背根神经节脉冲射频在感觉刺激电压为0.3 V时,延长脉冲射频作用时间有助于缓解神经根性颈椎病根性疼痛,但12 min可能会导致神经损伤。

Objective It is to evaluate the effectiveness and safety of prolonging the action time of pulsed radiofrequency under constant sensory stimulation voltage of dorsal root ganglion in the treatment of cervical spondylotic radiculopathy.Methods A total of 121 patients with cervical radiculopathy diagnosed and treated in Union Hospital of Tongji Medical College of Huazhong University of Science and Technology from May 2016 to August 2019 were randomly divided into 3 groups:8 min pulse radio frequency group,10 min pulse radio frequency group,and 12 min pulse radio frequency group,their stimulation voltage were all 0.3 V,and the pulse radio frequency action time was 8 min,10 min,and 12 min,respectively.The VAS scores of the patients in the 3 groups before operation and 1 d,7 d,14 d,30 d,60 d,and 90 d after the operation were recorded.According to the Odom classification,the excellent and good rates of the 3 groups were evaluated at 1 d,30 d,and 90 d after the operation,and the complications of the 3 groups were recorded at the same time.Results Ninety cases of investigators were finally completed,30 cases in each group.The VAS scores of the three groups at each time point after surgery were significantly lower than those before surgery(P<0.05),but there was no significant difference in the VAS scores of the three groups at 1 d,7 d,14 d,30 d,and 60 d after surgery(all P>0.05).The VAS score of the 12 min pulsed radio frequency group was significantly lower than that of the 8 min pulsed radio frequency group and the 10 min pulsed radio frequency group(P<0.05).There was no significant difference in the excellent and good rates of the 3 groups at 1 d and 30 d after operation(all P>0.05).The excellent and good rates of the 12 min pulsed radio frequency group were significantly higher than those of the 8 min pulsed radio frequency group and the 10 min pulsed radio frequency group(all P<0.05).There was no short-term pain aggravation,sensory disturbance and muscle strength changes in the three groups,there was no obvious numbness and weakness in the 8 min pulsed radio frequency group and the 10 min pulsed radio frequency group;the patients in the 12 min pulsed radio frequency group complained of numbness,and all recovered within 1 week.Conclusion When the dorsal root ganglion pulsed radio frequency is 0.3 V,prolonging the action time of pulsed radio frequency can help relieve the radiculopathy of cervical radiculopathy,but 12 minutes may cause nerve damage.