比较A型肉毒毒素竖脊肌注射和内热针疗法对软组织源性腰椎术后疼痛综合征患者的疗效

Comparison of effects between botulinum toxin type A injection at erector spinae and internal heated needle therapy on the patients with soft tissue-derived failed back surgery syndrome

目的比较超声引导下A型肉毒毒素注射疗法和内热针疗法对于软组织源性腰椎术后疼痛综合征的治疗效果。方法回顾性分析2019年1月至2019年12月佛山市禅城区中心医院疼痛科收治的软组织源性腰椎术后疼痛综合征患者60例,依据治疗方式不同分为A型肉毒毒素组和内热针组,各组30例。其中A型肉毒毒素组,超声引导下在手术相关节段竖脊肌内注射A型肉毒毒素,总量≤100 U;内热针组,采用内热针进行治疗,超声引导下在手术相关节段软组织选点布针,靶点20~30个,治疗时间为20 min,治疗温度42℃。两组患者均每3日做1次治疗,住院期间共接受2次治疗。治疗前及治疗后24 h、3 d及1、2、3个月时记录视觉模拟评分(VAS),治疗后24 h、3 d及1、2、3个月时记录Oswestry功能障碍指数。结果两组患者治疗前VAS评分及Oswestry功能障碍指数差异均无统计学意义(t=1.53,P>0.05;t=-0.05,P>0.05)。治疗前后不同时点VAS评分差异有统计学意义(F=327.40,P<0.05),时间与组间存在交互作用(F=31.47,P<0.05),治疗后两组之间VAS评分差异有统计学意义(F=734.65,P<0.05);治疗前后不同时点Oswestry功能障碍指数差异有统计学意义(F=475.65,P<0.05),时间与组间存在交互作用(F=64.29,P<0.05),内热针组Oswestry功能障碍指数优于A型肉毒毒素组(F=96.85,P<0.05)。结论内热针疗法能显著缓解软组织源性腰椎术后疼痛综合征患者的疼痛,其疗效优于A型肉毒毒素竖脊肌注射治疗。

Objective To compare the efficacy of paravertebral injection of botulinum toxin type A(BoNT-A)with silver needle therapy in the treatment of patients with failed back surgery syndrome induced by soft-tissue.Methods Sixty patients,from January 2019 to December 2019,in Pain Department of Foshan Chancheng Central Hospital,were collected in this retrospective study.All patients were divided into BoNT-A group and internal heated needle group according to the treatment method,30 cases in each group.Patients were received BoNT-A≤100 U in paravertebral muscles in BoNT-A group,while patients were received internal heated needle therapy,20-30 target points,20 min,42℃,at soft tissue in the surgical area or adjacent segments in internal heated needle group.All patients were received the treatment once every 3 days,and 2 times during hospitalization in the two groups.VAS and Oswestry disability index were recorded before the treatment and 24 h,3 d,and 1,2,3 months after the treatment.Results There was no significant difference in VAS and Oswestry disability index before the treatment between two groups(t=1.53,P>0.05;t=-0.05,P>0.05).Comparing with pretreatment,VAS was significantly different at each time point between two groups after the treatment(F=327.40,P<0.05),and there was an interaction between time and group(F=31.47,P<0.05),there was significantly different in VAS between two groups(F=734.65,P<0.05).Oswestry disability index was significantly different at each time point between the two groups(F=475.65,P<0.05),and there was an interaction between time and group(F=64.29,P<0.05).Oswestry disability index in internal heated needle group was superior to BoNT-A group(F=96.85,P<0.05).Conclusions Internal heated needle therapy can relieve the pain in patients with soft tissue-derived failed back surgery syndrome,and is superior to the injection of soft tissue botulinum toxin type A in the paravertebral muscles.