腰神经内侧支不同温度射频热凝治疗慢性腰痛疗效分析

Clinical effect of lumbar nerve medial branch radiofrequency thermocoagulation at different temperatures for chronic low back pain

目的:观察腰神经内侧支进行75℃和90℃射频热凝治疗对慢性腰痛病人疼痛及运动功能改善情况。方法:采用前瞻性随机对照研究,选取2021年1月至2022年1月中日友好医院疼痛科符合纳入标准的慢性腰痛病人200例,按随机数字表法分为75℃组(n=100)和90℃组(n=100),治疗后1个月、3个月和6个月评价主要终点指标为疼痛数字评分法(numerical rating scale,NRS)评分(0~10分)以及疼痛降低2分以上病人比例(临床显著差异性最小差值),次要终点指标为腰椎Oswestry功能障碍指数(Oswestry dysfunction index,ODI)评分降低15分以上病人比例。结果:NRS评分变化第3个月和6个月75℃组和90℃组相比差异有统计学意义(-2.1 vs.-2.8,-2.0 vs.-2.8,P<0.05),第1、3和第6个月90℃组NRS评分降低≥2分病人比例更高(71.9%vs.81.4%,71.9%vs.80.4%,72.5%vs.82.6%,P<0.05)。ODI评分变化第3个月和6个月75℃组和90℃组相比差异有显著统计学意义(-13.6 vs.-18.6,-11.1 vs.-17.7,P<0.001),第1、3和第6个月90℃组ODI评分降低≥15分比例更高(68.8%vs.78.4%,64.0%vs.73.9%,55.0%vs.70.0%,P<0.05)。结论:对腰神经内侧支进行射频热凝治疗90℃比75℃效果更显著。

Objective:To observe the effect of lumbar nerve medial branch radiofrequency thermocoagulation at 75℃and 90℃on pain and motor function in patients with chronic low back pain.Methods:A prospective randomized controlled study was conducted.From January 2021 to January 2022,patients with nonspecific chronic low back pain who met the inclusion criteria in the Pain Department of China-Japan Friendship Hospital were selected and randomly divided into 75℃group(n=100)and 90℃group(n=100).The primary endpoint was numerical rating scale(NRS)pain score(0-10 points)and the proportion of patients with pain reduction of more than 2 points(minimum difference of clinical significant difference)were evaluated at the time of 1 month,3 months and 6 months after treatment.The secondary endpoint was lumbar Oswestry dysfunction index(ODI)score and the proportion of patients with ODI reduction of more than 15 points.Results:There was a statistically significant difference of NRS score change(-2.1 vs.-2.8,-2.0 vs.-2.8,P<0.05)between the 75℃group and the 90℃group at the time of 3 and 6 months after treatment.The proportion of patients with NRS score reduction≥2 points in the 90℃group was higher(71.9%vs.81.4%,71.9%vs.80.4%,72.5%vs.82.6%,P<0.05)at the time of 1,3 and 6 months after procedure.There was a statistically significant difference of ODI score change between the 75℃group and the 90℃group in the 3 and 6 months(-13.6 vs.-18.6,-11.1 vs.-17.7,P<0.001).The proportion of ODI score reduction≥15 points in the 90℃group was higher(68.8%vs.78.4%,64.0%vs.73.9%,55.0%vs.70.0%,P<0.05)at the different time of 1,3 and 6 months after treatment.Conclusion:Radiofrequency thermocoagulation of lumbar nerve medial branch at 90℃is more effective than 75℃.