颈椎脊神经后支射频凝术有性的随机对照研究颈椎脊神经后支射频凝术有效性的随机对照研究.docVIP

颈椎脊神经后支射频热凝术有效性的随机对照研究 廖翔 蒋劲 熊东林 张强 肖礼祖 郑虎山 沙彤 梁豪文 罗裕辉 (深圳市第六人民医院疼痛科,深圳518052) 摘要目的:通过随机对照研究,评价射频热凝术治疗颈椎脊神经后支诱发慢性颈肩痛的有效性。 方法:自2005年12月至2008年12月共127名患者纳入研究,所有病人均经诊断性颈椎脊神经后支阻滞有效,明确为颈椎脊神经后支诱发慢性颈肩痛。随后随机分为两组,A组采用DSA影像引导下脊神经后支射频热凝术治疗,B组采用口服药物保守治疗,随访期2年。利用视觉模拟评分法(VisualAnalogScores,VAS)进行治疗前后疗效评定。以VAS评分小于治疗前的50%视为优良疗效,反之视为疗效不佳。利用Kaplan-Meier生存曲线与Log-Rank检验进行两组疗效对比。记录手 术并发症与用药副作用。结果:A组VAS评分回到术前50%的平均时间是217天,B组为27天(P0.01)。在第27周(治疗后200天),A组36名患者完全无痛,B组为1名。A组术后疗效优良率显著高于B组(P0.01)。B组3例病人出现胃部不适,纳差,经对症治疗后消失。A组9例病人术后出现神经支配区域的皮肤麻木,无感染及脊神经前支、椎动脉损伤等并发症。 结论:对于颈椎脊神经后支诱发慢性颈肩痛,颈椎脊神经后支射频热凝术相比保守治疗,能够更有效的长期缓解疼痛,且操作安全,副作用很少。 关键词颈椎脊神经后支;射频热凝;随机对照研究 PERCUTANEOUS RADIOFREQUENCY NEUROTOMY FOR CHRONIC CERVICAL ZYGAPO- PHYSEAL JOINT PAIN: A RANDOMIZED CONTROLLED TRIAL LIAO Xiang, JIANG Jin, XIONG Dong-Lin, ZHANG Qiang, XIAO Li-Zu, ZHENG Hu-Shan, SHA Tong,Liang Hao-Wen, LUO Yu-Hui ( Department of Pain Medicine, the Sixth People’s Hospital in Shenzhen, Shenzhen 518052) Abstract Objective: To compare the efficacy of percutaneous radiofrequency thermocoagulation of the medial branches of the cervical dorsal rami and conservative treatment in patients with chronic neck and shoulder pain through a randomized controlled trials. Methods: From Dec. 2005 to Dec. 2008, 127 patients with chronic neck and shoulder pain were enrolled into this study and were randomly divided into two groups. All patients had a diagnosis of chronic neck and shoulder pian established by controlled medial branch blocks. Under the guidance of DSA, group A were treated with percutaneous radiofrequency therm-ocoagulation of the medial branches of the cervical dorsal rami via lateral approach. Group B were treated with NSAIDs drug. The efficacy including VAS scores and Kaplan-Meier curve of the treatment from both groups were recorded till the 24th month and analyzed for comparison. Side effects and complications were recorded. Results: The median time that elapsed before the pain return to at least 50% of the preoperative