短时程脊髓电刺激与脉冲射频调节治疗带状疱疹相关性疼痛的疗效及安全性比较

Short-term spinal cord stimulation and pulsed radiofrequency for zoster-associated pain:an efficacy and safety comparisive study

目的对比分析短时程脊髓电刺激(st-SCS)与脉冲射频调节(PRF)治疗带状疱疹相关性疼痛(ZAP)的近远期疗效及安全性。方法选择自2019年1月至2021年9月于山东大学附属省立医院疼痛科接受st-SCS或PRF治疗的208例ZAP患者为研究对象,按照治疗方式的不同分为st-SCS组(107例)与PRF组(101例),经1:1倾向评分匹配平衡2组患者的基线资料差异后,对2组匹配后各86例患者的术前、术后3d、术后7d、出院时及术后1、3、6、12、24个月的数字评估量表(NRS)评分以及NRS缓解率、药物用量、匹兹堡睡眠质量指数(PSQI)、并发症发生情况等资料进行对比分析。结果st-SCS组与PRF组患者术后3d、术后7d、出院时及术后1、3、6、12、24个月的NRS评分均较术前明显降低,出院时及术后1、3、6、12个月时st-SCS组患者的NRS评分明显低于PRF组,差异均有统计学意义(P<0.05)。出院时及术后1、3、6、12、24个月时st-SCS组患者的NRS缓解率明显高于PRF组,术后1、3、6、12个月时st-SCS组患者的总有效率明显高于PRF组,差异均有统计学意义(P<0.05)。st-SCS组与PRF组患者术后1、3、6、12、24个月的普瑞巴林、加巴喷丁用量均较术前明显减少,术后3个月时st-SCS组患者的加巴喷丁用量明显低于PRF组,差异均有统计学意义(P<0.05)。st-SCS组与PRF组患者出院时及术后6、12、24个月的PSQI均较术前明显降低,出院时及术后6、12、24个月时st-SCS组患者的PSQI明显低于PRF组,差异均有统计学意义(P<0.05)。st-SCS组与PRF组患者中均无严重并发症如硬脊膜外血肿形成、脊神经根或脊髓损伤等发生。结论st-SCS与PRF均可安全有效地治疗ZAP,但st-SCS比PRF更具优势。

Objective To compare the short-term and long-term efficacies and safety of shortterm spinal cord stimulation(st-SCS)and pulsed radiofrequency(PRF)in treating zoster-associated pain(ZAP).Methods A total of 208 ZAP patients who received treatment in Department of Pain Management,Provincial Hospital Affiliated to Shandong University from January 2019 to September 2021 were selected.They were divided into st-SCS group(n=107)and PRF group(n=101)according to different treatments.After differences of baseline data being balanced by 1:1 propensity score matching between the two groups,scores of numerical rating scale(NRS),NRS remission rate,drug dosage,Pittsburgh Sleep Quality Index(PSQI)and complications of 86 patients from each 2 groups were compared and analyzed before surgery,3 and 7 d after surgery,at discharge,and 1,3,6,12 and 24 months after surgery.Results NRS scores in st-SCS group and PRF group 3 and 7 d after surgery,at discharge,and 1,3,6,12 and 24 months after surgery were significantly lower than those before surgery(P<0.05).NRS scores in st-SCS group were significantly lower than those in PRF group at discharge and 1,3,6 and 12 months after surgery(P<0.05).NRS remission rate in st-SCS group was significantly higher than that in PRF group at discharge and 1,3,6,12 and 24 months after surgery,and total effective rate in st-SCS group was significantly higher than that in PRF group 1,3,6,and 12 months after surgery(P<0.05).The pregabalin and gabapentin dosages in st-SCS group and PRF group 1,3,6,12,and 24 months after surgery were significantly lower than those before surgery,and the gabapentin dosage in st-SCS group was significantly lower than that in PRF group 3 months after surgery(P<0.05).PSQI in st-SCS group and PRF group at discharge and 6,12 and 24 months after surgery was significantly decreased compared with that before surgery,and PSQI in st-SCS group at discharge and 6,12 and 24 months after surgery was significantly decreased compared with that in PRF group(P<0.05).No serious complications as spinal epidural hematoma or spinal nerve root and spinal cord injuries occurred in st-SCS group and PRF group.Conclusion Both st-SCS and PRF can treat ZAP safely and effectively,but st-SCS has more advantages than PRF.