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论著:射频毁损脊神经后内侧支治疗腰椎小关节病变所致慢性腰痛的疗效
Effects of Radiofrequency Neurotomy on Medial Branch of Dorsal Rami on Patients with Chronic Low-Back Pain from the Disfunction of Lumbar Facet Joints
张光明 唐坤 陈俊峰
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作者单位:上海市长宁区中心医院麻醉科
中文关键字:射频;腰椎小关节;C型臂X光机;慢性腰痛;双氯芬酸钠
英文关键字:Radiofrequeney; Lumbar facet joint;C-arm X-ray; Chronic low back pain;Diclofenac sodium
中文摘要:目的:评估射频毁损脊神经后内侧支治疗腰椎小关节病变所致慢性腰痛的疗效。方法:将腰痛时间长于3个月、腰椎小关节处有固定压痛以及影像学检查诊断为腰椎小关节病变的40例患者随机分为射频组(n=20)和消炎镇痛药组(n=20)。射频组患者在C型臂X线机引导下将射频穿刺针刺到脊神经后内侧支所对应小关节的上关节突与相应横突根部交界处,确认位置后行感觉测试和运动测试,如无异常进行射频热凝治疗。消炎镇痛药组患者口服双氯芬酸钠。腰痛程度采用视觉模拟评分法(visual analogue scale, VAS)评分。治疗前(T0)和治疗后3个月(T1)观察患者的生命体征和VAS评分。根据治疗过程中VAS改善程度统计疗效(分为显效、有效和无效)。结果:治疗后3个月总有效率射频组为87.6%,消炎镇痛药组为46.5%;显效率射频组为76.2%,消炎镇痛药组为26.4%。射频组的总有效率和显效率均显著高于消炎镇痛药组(P< 0.01)。结论:C型臂X线机引导射频毁损脊神经后内侧支治疗能有效缓解腰椎小关节病变所致慢性腰痛,疗效优于口服药物治疗。
英文摘要:Objective: To investigate the effects of radiofrequency neurotomy on medial branch of dorsal rami on patients with chronic low-back pain from the disfunction of lumbar facet joints. Methods: A total of 40 patients, who had low-back pain from the disfunction of lumbar facet joints more than 3 months, were enrolled in this study. The patients were randomly divided into radiofrequency group and medicine group(n=20). The radiofrequency needle was punctured into the juncture of superior articular process and transverse process related to medial branch of dorsal ramus under the guidance of C-arm X-ray machine in radiofrequency group. The radiofrequency parameter was set at 80℃ of temperature and 120s of duration after sensory and motor test. The medicine group received taking Diclofenac Sodium. The vital signs and visual analogue scale were recorded before the treatment(T0) and 3 months after the treatment(T1). The effects of treatment were evaluated according to the changes of VAS and were divided into excellence, effectiveness, inefficiency. Results: There was a higher effective and excellence rate at T1 in the radiofrequency group than in the medicine group(P<0.01). The total effective rate at T1 in radiofrequency group was 87.6% and in medcine group was 46.5%. The rate of excellence effect in radiofrequency group was 76.2% and in medcine group was 26.4%. Conclusions: There is a better effect with radiofrequency neurotomy on medial branch of dorsal rami on patients with chronic low-back pain from the disfunction of lumbar facet joints.
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