颈源性头痛患者采用触发点臭氧注射联合颈2背根神经节脉冲射频治疗的疗效观察

Efficacy of myofascial trigger points ozone injection combined with pulsed radiofrequency at C2 dorsal root ganglion for the treatment of patients with cervicogenic headache

目的评价触发点臭氧注射联合颈2(C2)背根神经节脉冲射频对颈源性头痛(CEH)的疗效。方法收集2020年10月至2021年6月于通辽市医院疼痛科就诊的CEH患者48例, 采用随机数字表法均分为射频组与联合组, 每组24例。射频组采用C2背根神经节脉冲射频治疗, 脉冲射频参数为针尖温度42 ℃、脉冲频率2 Hz、脉冲宽度20 ms、电压50~100 V、脉冲时间13 min;联合组采用C2背根神经节脉冲射频联合头颈部触发点臭氧水注射治疗, 脉冲射频治疗后的1、3、5 d根据头颈部疼痛区域选择触发点进行臭氧水注射, 每点2 ml(浓度23 μg/ml)。观察两组患者治疗前及治疗后1、3及6个月时视觉模拟评分(VAS)和颈椎功能障碍指数(NDI)。结果治疗后1、3、6个月时射频组VAS评分分别为[3.0(2.0)、3.0(1.0)及3.5(2.8)]分、NDI评分分别为[(10±4)、(12±4)及(13±6)]分, 联合组VAS评分分别为[1.0(1.8)、2.0(2.0)及2.5(2.8)]分、NDI评分分别为[(8±3)、(9±4)及(10±6)]分, 较同组治疗前VAS评分、NDI评分均显著降低, 差异均有统计学意义(P均<0.05);与射频组比较, 联合组患者治疗后1、3、6个月时VAS、NDI评分下降显著, 差异均有统计学意义(P均<0.05)。结论触发点臭氧注射联合C2背根神经节脉冲射频治疗颈源性头痛疗效确切, 效果优于单纯背根神经节脉冲射频治疗。

Objective To evaluate the therapeutic effect of combination of myofascial trigger points ozone solution injection and pulsed radiofrequency at C2 dorsal root ganglion in the treatment of patients with cervicogenic headache.Methods Forty-eight patients with cervicogenous headache,in the Department of Painology,Tongliao City Hospital from October 2020 to June 2021,were randomly divided into radiofrequency treatment group and combined treatment group by random number table method.The patients was treated with pulsed radiofrequency of C2 dorsal root ganglion in the radiofrequency group,with parameters of 42℃,frequency 2 Hz,pulse width 20 ms,voltage 50 to 100 V,13 min,and was treated with the pulse radiofrequency of C2 dorsal root ganglion and ozone solution injection at myofascial trigger points of head and neck in the combined group.Ozone solution was injected at myofascial trigger points in head and neck and 2 ml ozone solution(23μg/ml)at each point,1 day,3 days,5 days after the pulsed radiofrequency therapy.Visual analogue scale(VAS)and neck disability index(NDI)were observed before the treatment and 1 month,3 months and 6 months after the treatment.Results VAS and NDI were decreased significantly(all P<0.05),and the combined group was better than the pulse radiofrequency group,at 1 month,3 months and 6 months after treatment in the radiofrequency group[3.0(2.0),3.0(1.0),3.5(2.8)]and[(10±4)、(12±4)and(13±6)](all P<0.05),and in the combined group[1.0(1.8)、2.0(2.0),2.5(2.8)]and[(8±3),(9±4),(10±6)],respectively.Conclusion Myofascial trigger points ozone solution injection combined with pulsed radiofrequency at C2 dorsal root ganglion is effective in the treatment of cervical headache,and is better than that of pulsed radiofrequency alone.