脊神经后支内侧支射频去神经支配在高龄患者椎体压缩性骨折疼痛治疗中的应用

目的探讨高龄椎体压缩性骨折患者运用脊神经后支内侧支去神经支配技术对疼痛缓解、生活能力改善方面的有效性。方法对澳门地区70～94岁高龄椎体压缩性骨折患者，在DSA定位下行相应41例次骨折节段单侧或双侧脊神经后支内侧支去神经支配，用弯形尖针行后支内侧支穿刺，分别给予50Hz感觉、2Hz运动测试，70℃、90S两个射频周期的标准射频，共行122个脊神经后支射频的治疗，通过VAS评分、Barthel指数记分法、McGill评分，观察疼痛缓解、日常生活活动能力的改善。结果VAS评分、ADL评分和McGill评分术后1周较术前比较有明显改善（P〈0．001）。全组未见相应节段神经根损伤及皮肤感觉功能缺失等副作用。结论高龄椎体压缩性骨折患者选择相应节段的脊神经后支内侧支射频去神经支配术，具有镇痛好、安全、有利于生活质量提高的优点。

Denervation of spinal nerve medial branch with radiofrequency in the treatment of vertebral compression fracture pain

Objective To assess the efficacy of pain relief and improvement in activities of daily living after the treatment by denervating the medial branch of spinal nerve posterior branch, in the aged patients with vertebral compression fracture. Methods Thirty-eight elderly patients suffered from vertebral compression fracture, 70-94 years old in Macao, were received denervation in one or two-sides medial branch of spinal nerve posterior branch in 41 corresponsive fracture centrums under the guidance of DSA. The medial branch of spinal nerve posterior branch was punctured with curved and sharp needle, then 50 Hz sensory test and 2 Hz motor test to confirm it, and after that 70 ;C standard radiofrequency lasted 90 s,two periods was performed, including 122 ramus of spinal nerve. The efficacy of pain relief and improvement in activities of daily living were assessed by VAS, Barthel index of ADL, McGil Pain Questionnaire （MPQ）. Results VAS, ADL and MPQ scores at 1 week after the operation were better than that before the operation, which were significant difference （P; 0.01）. There were no damage to the nerve root and the corresponsive skin sensory in the treatment group. Conclusion The denervation of medical branch of spinal nerve posterior branch is a good choice to the aged patients for the treatment of vertebral compression fracture pain with effective analgesia, safety and has an advantage to improve the quality of daily living.