经椎小关节内侧缘入路靶点穿刺行射频热凝毁损术治疗顽固性椎间盘源性腰痛的效果

目的 观察经椎小关节内侧缘入路靶点穿刺行射频热凝毁损术治疗顽固性椎间盘源性腰痛的效果和安全性.方法 选择2010年5月至2014年11月我院收治的顽固性椎间盘源性腰痛患者69例,按随机数表法分为观察组(n=37)和对照组(n=32),观察组患者经椎小关节内侧缘入路靶点穿刺行射频热凝毁损术治疗,对照组患者经Kambin三角区穿刺行射频热凝毁损术治疗.分别于术前(T0)、术后7 d(T1)、术后1个月(T2)、术后3个月(T3)采用疼痛视觉模拟评分(VAS),奥斯维斯失能指数(Oswestry disability index,ODI)评价患者疼痛程度和腰痛功能障碍程度,详细记录患者治疗期间并发症发生情况,并进行组间比较.结果 观察组患者术后7 d的有效率为83.78%(31/37),对照组为78.13%(25/32),组间比较差异无统计学意义(P>0.05);T1~3时,两组患者的VAS、ODI评分均明显较T0时降低,而T1时,观察组患者VAS、ODI评分明显低于对照组,差异均有统计学意义(P<0.05);两组患者并发症发生率比较差异无统计学意义(P>0.05).结论 经椎小关节内侧缘入路靶点穿刺和经Kambin三角区穿刺行射频热凝毁损术治疗顽固性椎间盘源性腰痛均安全有效,但前者早期缓解患者疼痛和改善腰痛功能障碍效果较优.

Clinical effect and security of radiofrequency ablation through internal edge of vertebral facet joint in the treatment of intractable discogenic low back pain

Objective To discuss the clinical effect and security of radiofrequency ablation through internal edge of vertebral facet joint. Methods Sixty-nine patients with intractable discogenic low back pain in our hospital from May 2010 to November 2014 were selected and randomly divided into observational group (n=37) and control group (n=32) according to a random number table. Patients in the observation group were treated by radiofrequency abla-tion through internal edge of vertebral facet joint, and the patients in the control group were treated by radiofrequency ab-lation through Kambin's triangle. The Visual Analogue Scale (VAS), The Oswestry Disability Index (ODI) were used to evaluate the degree of pain and low back pain before operation (T0), and 7 d (T1), one month (T2), 3 months (T3) after operation. The complications during the treatment were recorded and compared between the two groups. Results The effective rate at T1 was 83.78%(31/37) in the observation group and 78.13%(25/32) in the control group, without statis-tically significant difference (P>0.05). Compared with T0, the VAS, ODI scores of the two groups at T1~3 were signifi-cantly reduced (P<0.05). At T1, the VAS, ODI scores of the observation group were significantly lower than those of the control group (P<0.05). There was no statistically significant difference in the incidence between the two groups (P>0.05). Conclusion Radiofrequency ablation through internal edge of vertebral facet joint and through Kambin's trian-gle are both safe and effective for treatment for intractable discogenic low back pain, but the former has more advanta-geous in relieving pain and improving the low back pain and dysfunction.