腰脊神经后内侧支射频热凝术联合腰椎旁密集型银质针治疗脊柱源性腹痛的疗效

Radiofrequency thermocoagulation in posterior medial branch of spinal nerve combined with lumbar paravertebrial intensive silver needle for treatment of spinal original abdominal pain

目的观察腰脊神经后内侧支射频热凝术联合腰椎旁密集型银质针治疗脊柱源性腹痛的临床疗效。方法收集2020年1月至2021年6月在滨州医学院附属医院疼痛科就诊的脊柱源性腹痛患者23例,年龄、性别不限,病程>3个月,腰椎旁存在多个压痛点,经相关科室排除消化系统、泌尿系统、妇科等疾患。给予腰部脊神经后内侧支射频热凝术(设置参数75℃、80 s),术后即刻选择腰椎棘突旁、椎板、关节突关节、横突等多个压痛点行密集型银质针导热治疗(设置参数110℃、20 min),于治疗前及治疗后1、4、12周时采用视觉模拟评分(VAS)及匹兹堡睡眠质量指数量表(PSQI)对患者进行疗效评定。结果治疗后1、4、12周时VAS评分分别为(2.4±1.0)、(1.0±0.8)、(0.8±0.7)分,治疗后1、4、12周时PSQI评分分别为(6.9±1.8)、(4.2±1.2)、(3.8±1.3)分,两者均较治疗前明显降低,差异有统计学意义(P均<0.05)。患者治疗后各时点VAS评分0~3分例数均显著高于治疗前(P均<0.05),但治疗后各时点间比较差异均无统计学意义(P均>0.05)。患者治疗后1、4、12周显效率分别为87.0%(20/23例)、95.7%(22/23例)、95.7%(22/23例),差异无统计学意义(χ^(2)=1.09,P=0.295),未见治疗相关不良反应发生。结论脊柱源性腹痛采用腰脊神经后内侧支射频热凝术联合腰椎旁密集型银质针治疗可显著缓解疼痛,改善睡眠质量。

Objective To observe the efficacy of radiofrequency thermocoagulation in posterior medial branch of spinal nerve combined with lumbar paravertebrial intensive silver needle in the treatment of abdominal pain of spinal origin(APSO).Methods Twenty-three patients with APSO in the Department of Painology of,Binzhou Medical University Hospital from January 2020 to June 2021 were collected,with disease course more than three months and without age and gender limitation.The patients have multiple tenderness points near lumbar vertebra,and were ruled out digestive system diseases,urinary system diseases and gynecological diseases.The patients were treated with radiofrequency thermocoagulation(75℃,80 s)in posterior medial branch of spinal nerve.Then intensive silver needle(110℃,20 min)was applied to the multiple tenderness points involving the lumbar spinal segment such as spinous process,vertebral lamina,facet joints and transverse processes immediately after radiofrequency thermocoagulation.Visual analogue scale(VAS)and Pittsburgh sleep quality index(PSQI)were evaluated before the treatment and 1,4 and 12 weeks after the treatment.Results At 1,4 and 12 weeks after the treatment,VAS was(2.4±1.0),(1.0±0.8)and(0.8±0.7)respectively,while PSQI was(6.9±1.8),(4.2±1.2)and(3.8±1.3)respectively,VAS and PSQI were significantly lower than those before the treatment(all P<0.05).The patients of VAS 0-3 after the treatment were much more than those before the treatment(all P<0.05),but there was no statistically significant difference at each time point after the treatment(all P>0.05).The effective rate was 87.0%(20/23 cases),95.7%(20/23 cases)and 95.7%(20/23 cases)at 1,4,12 weeks after the treatment respectively,with no statistically significant difference(χ^(2)=1.09,P=0.295).No serious adverse reactions were observed in the course of the treatment.Conclusion Radiofrequency thermocoagulation in posterior medial branch of spinal nerve combined with lumbar paravertebrial intensive silver needle has significant clinical efficacy in the treatment of APSO,with better pain relief and sleep quality improving.