影像引导下腰脊神经内侧支脉冲射频治疗腰椎小关节综合征

摘要

Objective To assess the therapeutic effect of imaging-guided pulsed-radiofrequency stimulation of medial branch of lumbar spinal nerve in treating lumbar facet joint syndrome. Methods A total of 48 patients with clinically-diagnosed lumbar facet syndrome were randomly divided into group A (anti-inflammatory and analgesic group, n=26) and group B (pulsed-radiofrequency group, n=22). The patients of group A received oral meloxicam dispersible tablets , while the patients of group B were treated with DSA-guided pulsed-radiofrequency stimulation of dorsal medial branch of lumbar spinal nerve corresponding to the diseased lumbar facet. Using visual analogue scale (VSA) the severity of pain at the time of admission, discharge and 6 month after discharge was separately evaluated , and the therapeutic effect was assessed based on the improvement of VSA score. Results The VAS scores of group A and group B at the time of discharge and 6 months after discharge were significantly lower than those determined at the time of admission (P<0.01). At the time of discharge, the VSA score of group B was significantly lower than that of group A (P<0.05). Six months after discharge, the VAS score of group B was significantly lower than that of group A (P<0.05). The total effective rates at 6 months after di scharge of group A and group B were 46.5% and 87.6% respectively;the excellent effect rates of group A and group B were 26.4% and 76.2% respectively. Both the total effective rate and excellent effect rate of group B were significantly higher than those of group A (P<0.01). Conclusion Imaging-guided pulsed-radiofrequency stimulation of dorsal medial branch of lumbar spinal nerve can effectively relieve chronic lower back pain caused by lumbar facet joint syndrome , and its therapeutic effect is superior to oral anti-inflammatory and analgesic medication.%目的：评估脉冲射频刺激脊神经后内侧支治疗腰椎小关节综合征的疗效。方法48例诊断为腰椎小关节综合征的患者随机分为消炎镇痛药组（A组=26例）和脉冲射频组（B 组=22例）。 A组患者口服美洛昔康分散片；B组患者行射频脉冲刺激脊神经后内侧支所对应小关节。采用视觉模拟评分（ VAS ），分别测评入院时、出院时及出院后6个月的 VAS 评分，并根据 VAS 改善程度统计疗效。结果出院时及出院后6个月时，A、B两组的VAS评分均较入院时有显著降低（P<0．01）；两组间VAS评分比较，出院时B组较A组降低，差异有统计学意义（P<0．05）。出院后6个月时B组较A组显著降低，差异有统计学意义（P<0．05）。治疗后6个月总有效率A组为46．5%，B组为87．6%；显效率B组为76．2%，A组为26．4%。 B组的总有效率和显效率均显著高于A组（P<0．01）。结论影像引导脊神经后内侧支脉冲射频术能有效缓解腰椎小关节综合征所致慢性腰痛，疗效优于口服药物治疗。