脉冲射频联合经椎间孔硬膜外类固醇注射对背根神经疼痛的疗效

Efficacy of the pulsed radiofrequency combined with transforaminal epidural steroid injection in the treatment of dorsal root nerve pain

目的:评估经X线精确定位椎间孔硬膜外类固醇注射联合腰背根神经节脉冲射频治疗(TESI+DRG-PRF)与单独经椎间孔硬膜外类固醇注射治疗(TESI)的慢性根性神经痛病人治疗效果,探讨联合治疗减轻慢性根性神经痛的疗效及对炎性因子的影响。方法:选取120例慢性根性神经痛病人为研究对象,其中57例行经椎间孔硬膜外类固醇注射治疗为对照组(TESI),63例行联合治疗为观察组(TESI+DRG-PRF)。比较2组术前和术后10 d,1、3和6个月疼痛数字评价量表(NRS)评分、Oswestry功能障碍指数(ODI)、MacNab标准优良率变化,比较治疗前、术后1个月血清白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)水平。结果:2组术后各时间点NRS评分、ODI评分均低于术前水平(P<0.05);观察组各时间点NRS评分、ODI评分低于对照组(P<0.05)。术后各时间点观察组MacNab优良率2组差异无统计学意义(P>0.05)。术后1个月,观察组IL-6、TNF-α水平较对照组降低(P<0.01)。术后1个月,ODI功能指数、NRS评分与IL-6、TNF-α水平均呈正相关(P<0.05~P<0.01)。结论:TESI+DRG-PRF联合治疗可更好缓解慢性根性神经痛病人疼痛症状,功能障碍改善可能与血清炎性因子水平降低有关。

Objective:To compare the effects between X-ray precise positioning epidural steroid injection combined with pulsed radiofrequency therapy(TESI+DRG-PRF) and transforaminal epidural steroid injection(TESI) alone in the treatment of patients with chronic root neuralgia,and explore the effects of combined treatment on the alleviating chronic root neuralgia and its influence on inflammatory factors.Methods:A total of 120 patients with chronic root neuralgia were selected as the research subjects,which included 57 patients treated with transforaminal epidural steroid injection as the control group(TESI) and 63 patients with combined treatment as the observation group(TESI+DRG-PRF).The pain numerical assessment scale(NRS) score,Oswestry disability index(ODI) and MacNab standard excellent and good rate were compared between two groups before operation and after 10 days,1 month,3 months and 6 months of operation.The serum levels of interleukin-6(IL-6) and tumor necrosis factor-α(TNF-α) were compared between two groups before treatment and after 1 month of operation.Results:The NRS score and ODI in two groups at each time point after operation were lower than those before operation(P0.05).After 1 month of operation,the serum levels of IL-6 and TNF-α in observation group were lower than those in control group(P<0.01).After 1 month of operation,the ODI and NRS score were positively correlated with levels of IL-6 and TNF-α(P<0.05 to P<0.01).Conclusions:The TESI+DRG-PRF combination therapy can better relieve the pain symptoms of patients with chronic root neuralgia.The improvement of dysfunction may be related to the reduction of serum inflammatory factors.