颈椎脊神经后支射频凝术有效性的随机对照研究.doc

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 P 0.01 。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 P 0.01 。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 leve