X线引导下颈脊神经后支松解治疗颈脊神经后支源性慢性颈肩痛的临床研究

Clinical Observation of X-ray Guided Neurolysis of Posterior Ramus of Cervical Spinal Nerve in the Treatment of Cervical Dorsal Rami Chronic Neck-shoulder Pain

目的观察在X线引导下行颈4、5脊神经后支松解治疗颈脊神经后支源性慢性颈肩痛的有效性及安全性。方法选取2020年12月至2021年4月武汉市第一医院疼痛科收治的颈脊神经后支源性慢性颈肩痛患者81例。所纳入研究的患者被随机分为两组,松解组(n=40)和阻滞组(n=41)。松解组在X线透视下采用一次性硬膜外穿刺针钝性分离颈4、5脊神经后支,并注射镇痛混合液(倍他米松4 mg+利多卡因40 mg,以盐水稀释至6~12 mL,各点约3 mL)。阻滞组单纯采用颈4、5脊神经后支注射镇痛混合液治疗方法(药物同松解组)。采用视觉模拟评分法(visual analogue scale, VAS)评估患者术前、术后1周、1月及6月疼痛程度;评估术后6月疗效。结果与术前相比,治疗后1周两组的疼痛评分均显著降低,差异有统计学意义(均P<0.05);治疗后1周,松解组与阻滞组患者疼痛评分差异无统计学意义(P>0.05);治疗后1月及6月,松解组患者的VAS评分明显低于阻滞组,差异有统计学意义(均P<0.05)。术后6月疗效评估,松解组(显著有效率93%)要明显优于阻滞组(显著有效率61%),差异有统计学意义(P<0.05)。两组患者术后即时及术后3 d均未出现局部血肿、感染、区域麻木等并发症。结论 X线引导下颈4、5脊神经后支松解术可长期有效改善患者颈肩部疼痛,具有安全、远期效果理想等特点,是颈脊神经后支源性慢性颈肩痛有效的治疗手段。

Objective To investigate the safety and efficacy of X-ray guided neurolysis of posterior ramus of cervical spinal nerve in the treatment of chronic cervical dorsal rami neck-shoulder pain.Methods A total of 81 patients with chronic cervical dorsal rami neck-shoulder pain in Wuhan No.1 Hospital admitted from December 2020 to March 2021 were enrolled in this study.The patients were randomly divided into two groups: neurolysis group(n=40)and nerve block group(n=41).In the neurolysis group, a disposable epidural needle was used for neurolysis of posterior rami of cervical spinal nerve under X-ray, and then analgesic mixture was injected(4 mg betamethasone and 40 mg lidocaine were diluted to 6-12 mL with normal saline, 3 mL mixture was injected into each point).In the nerve block group, patients were treated by a posterior cervical nerve branch injection with the same mixture as in the neurolysis group.Visual analogue scale(VAS)was used to assess pain severity before therapy as well as at 1 week, 1 month and 6 months after treatment.Efficacy was evaluated at 6 months after treatment in the two groups.Results VAS scores in both groups were significantly lower than th before the treatment(both P<0.05).There was no significant difference between the two groups at 1 week after the treatment(P>0.05)VAS in the neurolysis group was significantly lower than that in the nerve block group at 1 month and 6 months after the treatment(both P<0.05).Efficacy evaluation result in the neurolysis group(93%)was significantly higher than in the block group(61%)(P<0.05).No patient in both groups had complications such as regional hematoma, infection, or regional numbness.Conclusion X-ray guided neurolysis of posterior ramus of cervical spinal nerve can effectively relieve pain symptoms in patients with cervical dorsal rami neck-shoulder pain.This treatment is safe and effective for these patients.