CT引导下椎间孔穿刺射频热凝联合富血小板血浆注射治疗对上胸段顽固性带状疱疹后神经痛的临床疗效

Clinical efficacy of CT-guided interforaminal radiofrequency thermocoagulation combined with platelet-rich plasma injection in the treatment of refractory postherpetic neuralgia in the upper thoracic segment

目的 探究CT引导下椎间孔穿刺射频热凝联合富血小板血浆(PRP)注射治疗对上胸段顽固性带状疱疹后神经痛(PHN)患者的临床治疗效果。方法 回顾性选取2020年1月至2022年10月于四川绵阳四0四医院疼痛科接受治疗的上胸段顽固性PHN患者106例,根据治疗方式不同分为观察组(n=51)和对照组(n=55)。对照组采用CT引导下椎间孔穿刺射频热凝治疗,观察组在其基础上联合PRP注射治疗。治疗后2、4、8周,采用视觉模拟评分法(VAS)、匹兹堡睡眠质量指数(PSQI)、汉密顿抑郁量表(HAMD)及皮肤病生活质量指数(DLQL)分别评估所有患者的疼痛、睡眠质量、抑郁程度及生活质量变化。同时记录治疗过程中,患者不良反应发生情况。结果 治疗后4周,观察组VAS评分为(2.60±0.09)分,低于对照组[(3.24±0.53)分],差异有统计学意义(P<0.05)。治疗后2、8周,观察组PSQI评分分别为(11.07±0.96)、(7.50±0.44)分,均低于对照组[(12.04±2.23)、(8.94±0.11)分],差异均有统计学意义(P<0.05)。治疗后2、4、8周,观察组的HAMD评分分别为(9.68±1.23)、(5.67±1.26)、(2.69±0.53)分,低于对照组[(12.74±3..02)、(7.08±0.24)、(3.69±0.17)分],差异均有统计学意义(P<0.05)。治疗后8周,观察组DLQL评分为(3.25±0.73)分,低于对照组[(4.58±1.24)分],差异有统计学意义(P<0.05)。两组均未发生严重不良反应。结论 CT引导下椎间孔穿刺射频热凝联合PRP注射治疗可成功缓解上胸段顽固性PHN患者的症状,可有效减轻患者的抑郁程度,提高其睡眠质量和生活质量,值得临床重视。

Objective To explore the clinical effect of CT-guided interforaminal radiofrequency thermocoagulation combined with platelet-rich plasma(PRP)injection on patients with intractable postherpetic neuralgia(PHN)in the upper thoracic segment.Methods Retrospective analysis was performed on 106 patients with intractable PHN in the upper thoracic segment treated in the Department of Pain,Sichuan Mianyang 404 Hospital from January 2020 to October 2022,and they were divided into observation group(n=51)and control group(n=55)according to the different treatment methods.The control group was treated with CT-guided radiofrequency thermocoagulation for interforaminal puncture,and the observation group was treated with PRP injection.At 2,4 and 8 weeks after treatment,visual pain analog scale(VAS),Pittsburgh Sleep Quality Index(PSQI),Hamilton Depression Scale(HAMD)and Dermatology Life Quality Index(DLQL)were used to evaluate the changes in pain,sleep quality,degree of depression and quality of life of all patients.At the same time,the occurrence of adverse events in patients during the treatment was recorded.Results At 4 weeks after treatment,VAS score of observation group was(2.60±0.09)points,which was lower than the control group[(3.24±0.53)points],the difference was statistically significant(P<0.05).At 2 and 8 weeks after treatment,PSQI scores of observation group were(11.07±0.96)and(7.50±0.44)points,respectively,which were lower than those of the control group[(12.04±2.23)and(8.94±0.11)points],the differences were statistically significant(P<0.05).At 2,4 and 8 weeks after treatment,HAMD scores in observation group were(9.68±1.23),(5.67±1.26),and(2.69±0.53)points,respectively,which were lower than those in control group[(12.743.02),(7.08±0.24),and(3.69±0.17)points],the differences were statistically significant(P<0.05).At 8 weeks after treatment,DLQL score of observation group was(3.25±0.73)points,which was lower than control group[(4.58±1.24)points],the difference was statistically significant(P<0.05).No serious adverse reactions occurred in the two groups.Conclusion CT-guided radiofrequency thermocoagulation combined with PRP injection through intervertebral foramen puncture can successfully alleviate the symptoms of patients with refractory upper thoracic PHN,effectively alleviate the degree of depression,improve their sleep quality and quality of life,and is worthy of clinical attention.