颈神经后支与迷走神经调控治疗颈椎源性颈痛伴迷走神经功能失调患者的疗效

The effect of regulating the posterior branch of cervical nerve and vagus nerve on the changes of cervical symptoms in the treatment of cervical spondylosis

目的探究颈神经后支与迷走神经调控治疗颈椎源性颈痛伴迷走神经功能失调患者的疗效。方法回顾性分析2022年3月1日至2022年10月31日在首都医科大学宣武医院疼痛科住院治疗的颈椎源性颈痛患者40例,根据治疗方法分为射频组和药物组,每组20例。射频组患者采用颈神经后支与迷走神经调控治疗,患者取平卧位,经超声辨认颈椎处迷走神经,置入射频电极刺激,给予脉冲调节,温度42℃,射频时间120 s,循环3个周期;而后取患侧卧位,行患侧颈椎疼痛节段脊神经后支射频。药物组患者常规药物治疗,颈痛颗粒,1次1袋,1日3次,饭后服,两周为1疗程,共治疗4个疗程。比较两组患者的一般资料情况;观察对比两组患者治疗前、治疗后12个月时的疼痛程度[视觉模拟评分(VAS)]、颈椎活动度[关节活动度评分(ROM)]、头颈部僵硬感觉率、睡眠质量[匹兹堡睡眠指数量表(PSQI)]及生活质量[综合评定问卷(GQOL-74)]变化,评价并比较两组患者治疗后12个月时的总有效率;观察并比较治疗的不良反应、并发症发生情况及治疗后复发情况。结果射频组与药物组患者年龄、性别、病程、持续时间及发作次数对比差异无统计学意义(P>0.05)。与治疗前比较,两组患者治疗后12个月时VAS均明显降低,差异均有统计学意义(P均<0.05);治疗后12个月时,射频组患者的VAS明显低于药物组,差异有统计学意义(P<0.01)。与治疗前比较,两组患者治疗后12个月时的ROM评分、头颈部僵硬感觉率均降低,差异均有统计学意义(P均<0.05);治疗后12个月时,射频组ROM评分及头颈部僵硬感觉率低于药物组,差异有统计学意义(P<0.05)。与治疗前比较,两组患者治疗后12个月时,PSQI评分均明显降低,差异均有统计学意义(P均<0.05);治疗后12个月时,射频组患者的PSQI评分明显低于药物组,差异有统计学意义(P<0.01)。与治疗前比较,两组患者心理功能、社会功能、躯体功能、物质生活评分均升高,差异均有统计学意义(P均<0.05);治疗后12个月时,射频组心理功能、社会功能、躯体功能、物质生活评分均高于药物组,差异均有统计学意义(P均<0.01)。治疗后12个月时,射频组患者有效率[100%(20/20例)]明显高于药物组[80.0%(16/20例)],差异有统计学意义(P<0.05)。两组患者不良反应对比无统计学差异(χ^(2)=0.96,P=0.33>0.05)。射频组治疗后12个月内复发率低于药物组(χ^(2)=4.33,P=0.04<0.05)。结论颈神经后支射频与迷走神经调控治疗颈椎源性颈痛具有良好临床效果。

Objective To explore the effect of regulating the posterior branch of the cervical nerve and vagus nerve on cervical symptoms in the treatment of cervical spondylosis with vagus nerve dysfunction.Methods Forty patients with cervical spondylogenic neck pain hospitalized in the Department of Pain,Xuanwu Hospital,Capital Medical University from March 1 to October 31,2022 were retrospectively analyzed and divided into radiofrequency group and medication group according to the treatment methods,with 20 cases in each group.Patients in the radiofrequency group were treated with cervical dorsal ramus and vagus nerve regulation therapy,the temperature 42℃,the radiofrequency time 120 s,and 3 cycles.Patients in the medication group were treated with routine medication,Jingtong Granules,1 bag once,3 times a day for 8 weeks.The visual analogue scale(VAS),cervical joint range of motion(ROM),head and neck stiffness rate,Pittsburgh Sleep Quality Index(PSQI)and General Quality of Life(GQOL-74)were compared between the two groups before the treatment and 12 months after the treatment.The total effective rate was compared at 12 months after the treatment between the two groups.The adverse reactions,complications and recurrence after treatment were observed.Results Compared with before the treatment,the VAS were significantly decreased at 12 months after the treatment in the two groups(all P<0.05),and radiofrequency group was significantly better than medication group(P<0.01).Compared with before the treatment,the ROM score and head and neck stiffness were all significantly improved in the two groups at 12 months after the treatment(all P<0.05),and radiofrequency group were significantly better than medication group(P<0.05).Compared with before the treatment,the PSQI scores were significantly improved in the two groups at 12 months after the treatment(all P<0.05),and radiofrequency group were significantly better than medication group(P<0.01).The scores of psychological function,social function,physical function and material life in the two groups were all significantly higher after the treatment than that before the treatment(all P<0.05),and radiofrequency group were all significantly higher than medication group(all P<0.01).The effective rate in the radiofrequency group[100%(20/20 cases)]was significantly higher than that in the medication group[80.0%(16/20 cases)](P<0.05)at 12 months after the treatment.No significant difference in adverse reactions happened in the two groups(χ^(2)=0.96,P=0.33>0.05).The recurrence rate was lower in the radiofrequency group than that in the medication group(χ^(2)=4.33,P=0.04<0.05)within 12 months after the treatment.Conclusion Radiofrequency and vagus nerve regulation in the posterior branch of the cervical nerve have good effects in the treatment of cervical spondylosis.