脊柱内窥镜下腰脊神经背内侧支射频消融术治疗慢性腰椎小关节源性腰痛

目的探讨脊柱内窥镜下腰脊神经背内侧支射频消融术治疗中老年慢性腰椎小关节源性腰痛的近期疗效。方法采用回顾性队列研究的方法,选取2015年9月-2017年9月杭州市中医院收治的28例慢性腰椎小关节源性腰痛患者,其中14例采用脊柱内窥镜下腰脊神经背内侧支射频消融术治疗(手术组),14例采用经皮腰椎关节突关节封闭治疗(非手术组)。分别对2组患者进行电话、门诊随访,记录治疗前及治疗后1周、1个月、3个月、6个月、1年的腰痛视觉模拟量表(VAS)评分、日本骨科学会(JOA)评分和Oswestry功能障碍指数(ODI)并进行比较,评估2种治疗方案近期疗效的差异。结果治疗前2组患者VAS评分、JOA评分和ODI差异均无统计学意义(P>0.05)。治疗后2组患者各时间点VAS评分、JOA评分和ODI均较治疗前改善,其中手术组与治疗前相比差异有统计学意义(P<0.05);手术组患者VAS评分、JOA评分和ODI的改善情况均优于非手术组,差异有统计学意义(P<0.05)。结论脊柱内窥镜下腰脊神经背内侧支射频消融术治疗慢性腰椎小关节源性腰痛能够显著缓解患者症状、改善预后,近期疗效较好,相比经皮腰椎关节突关节封闭具有一定优势。

Radiofrequency ablation of dorsal medial branch of lumbar spinal nerve for chronic low back pain of lumbar facet joint origin under spinal endoscope

Objective To explore the short-term effects of radiofrequency ablation of the dorsal medial branch of lumbar spinal nerve in the treatment of chronic low back pain of lumbar facet joint origin. Methods A retrospective cohort study was conducted in 28 patients with chronic low back pain of lumbar facet joint origin admitted to Hangzhou Hospital of Traditional Chinese Medicine from September 2015 to September 2017,14 of which underwent radiofrequency ablation of the medial branch under a spinal endoscope(surgery group),and 14 patients underwent percutaneous zygapophysial joint blocks(conservation group). The 2 groups of patients were followed up by telephone and clinic,and the visual analogue scale(VAS) score,Japanese Orthopaedic Association(JOA) score and Oswestry disability index(ODI) of each patient were recorded and compared before treatment and 1 week,1 month,3 months,6 months and 1 year after treatment. And the data were statistically analyzed to assess the difference in short-term efficacy of the 2 treatment regimens. Results There were no significant differences in the scores of VAS,JOA and ODI between the 2 groups before treatment(P>0.05). The scores of VAS,JOA and ODI were improved after treatment compared before treatment in both groups,and with significantly difference in surgery group(P<0.05). The VAS scores,JOA scores and ODI of the patients in surgery group were better than those in conservation group(P<0.05). Conclusion Radiofrequency ablation of the dorsal medial branch of lumbar spinal nerve used in patients with chronic low back pain of lumbar facet joint origin can significantly relieve the symptoms,improve the prognosis with a good short-term efficacy. It has certain advantages over the traditional treatment of percutaneous zygapophysial joint blocks.