射频治疗老年人腰椎关节突关节疼痛的前瞻性研究

A prospective study of radiofrequency in the treatment of lumbar facet joint pain in the elderly

目的观察脊神经后支内侧支射频热凝微创手术治疗老年人腰椎关节突关节(LFJ)疼痛的疗效。方法选择60岁及以上LFJ疼痛患者,采用随机对照方法分为射频组和对照组,主要观察指标疼痛数字等级评分(NRS)和NRS降低2分及以上患者比例,次要观察指标腰椎功能障碍指数评分(ODI)和ODI降低15分及以上患者比例,以及Macnab标准疗效评定结果。结果符合纳入标准患者共270例分为射频组和对照组各135例,其中女性171例、男性99例。射频组第1、第3和第6个月NRS评分与基线值比较的变化较对照组的差异有统计学意义[(-2.3±1.1)分比(-1.2±1.2)分、(-2.3±1.1)分比(-1.2±1.2)分、(-2.3±1.1)分比(-1.2±1.2)分,t=13.204、16.366、20.319,均P<0.001],NRS降低≥2分患者比例第3、第6个月明显高于对照组[61.1%(80/131)比26.0%(32/123)、52.9%(64/121)比22.5%(25/111),χ^(2)=18.287、11.844,均P<0.001]。射频组第1、第3和第6个月ODI评分与基线值比较的变化较对照组的差异也有统计学意义[(-15.2±6.7)分比(-10.1±7.4)分、(-14.6±6.8)分比(-8.6±6.2)分、(-13.6±8.8)分比(-7.7±9.2)分,t=5.563、8.912、7.721,均P<0.001],ODI降低≥15分比例第3、第6个月也高于对照组[45.8%(60/131)比34.1%(42/123)、36.4%(44/121)比27.0%(30/111),χ^(2)=6.668、9.825,P=0.024、0.031]。射频组第6个月Macnab疗效评价优良率[60.3%(73/121)]和有效率[81.0%(98/121)],均明显优于对照组36.0%(40/111)和54.1%(60/111)(χ^(2)=11.787、8.890,均P<0.001)。结论脊神经后支内侧支射频热凝微创手术能有效减轻老年人LFJ疼痛、改善运动障碍,术后6个月疗效良好。

Objective To examine the effect of minimally invasive radiofrequency(RF)thermocoagulation of the posterior medial branch of the spinal nerves on lumbar facet joint(LFJ)pain in the elderly.Methods Patients over 60 years old with LFJ pain were randomly divided into an RF group and a control group.The primary outcome measures were the numerical rating scale(NRS)for pain assessment and the proportion of patients whose NRS decreased by 2 points or more,while the secondary outcome measures were the lumbar Oswestry dysfunction index(ODI),the proportion of patients whose ODI score decreased by 15 points or more,and the Macnab criteria.Results Patients who met the inclusion criteria were divided into an RF group and a control group,with 135 patients in each group,including 171 women and 99 men.Compared with baseline values,changes in NRS scores in the RF group were significantly different from those in the control group at the 1st,3rd and 6th months[(-2.3±1.1)vs.(-1.2±1.2),(-2.3±1.1)vs.(-1.2±1.2),(-2.3±1.1)vs.(-1.2±1.2),t=13.204,16.366,20.319,all P<0.001],and the proportions of patients whose NRS decreased by≥2 at the 3rd and 6th months were higher in the RF group than in the control group[61.1%(80/131)vs.26.0%(32/123),52.9%(64/121)vs.22.5%(25/111),χ^(2)=18.287,11.844,both P<0.001].Compared with baseline values,there were also significant differences in ODI score changes between the RF group and the control group at the 1st,3rd and 6th months[(-15.2±6.7)vs.(-10.1±7.4),(-14.6±6.8)vs.(-8.6±6.2),(-13.6±8.8)vs.(-7.7±9.2),t=5.563,8.912,7.721,all P<0.001],and the proportions of ODI reduction≥15 were higher in the RF group than in the control group at the 3rd and 6th months[45.8%(60/131)vs.34.1%(42/123),36.4%(44/121)vs.27.0%(30/111),χ^(2)=6.668,9.825,P=0.024,0.031].The proportions of patients achieving outcomes categorized as excellent and effective based on the Macnab criteria were significantly higher in the RF group than in the control group at the 6th month[60.3%(73/121)vs.36.0%(40/111),81.0%(98/121)vs.54.1%(60/111),χ^(2)=11.787,8.890,both P<0.001].Conclusions Minimally invasive radiofrequency thermocoagulation in the posterior medial branch of the spinal nerves can effectively reduce pain of the lumbar facet joints and improve movement disorders in the elderly,and the therapeutic effect is good 6 months after the procedure.