腰神经后支射频与阻滞对腰椎压缩骨折疼痛效果比较

目的比较腰神经后支射频消融与神经阻滞治疗老年腰椎压缩骨折疼痛近期、远期效果和安全性。方法将老年骨质疏松性腰椎压缩骨折病人60例分为两组,各30例。观察组给予腰神经后支射频治疗,对照组给予腰神经后支神经阻滞治疗,分别于治疗前1d及治疗后1d、5d、3个月、6个月,对病人行总体疼痛视觉模拟（VAS）评分和OSWESTRY功能障碍指数问卷（ODI）评分。结果与治疗前相比,观察组治疗后各时间点VAS评分及ODI评分均明显下降,差异有显著性（F=23.770、414.821,q=9.969～46.117,P〈0.01）;对照组术后1、5dVAS评分及ODI评分明显下降,差异有显著性（F=21.004、354.325,q=5.064～40.039,P〈0.05）。与对照组比较,观察组术后1、5dVAS评分及ODI评分差异无显著性（P〉0.05）,术后3、6个月VAS评分及ODI评分明显下降,差异有显著性（t=4.814～26.612,P〈0.05）。结论腰神经后支射频治疗老年腰椎压缩骨折疼痛的远期疗效明显优于神经阻滞治疗。

A COMPARISON OF ANALGESIC EFFECT BETWEEN RADIOFREQUENCY OF POSTERIOR RAMUS OF LUMBAR NERVE AND BLOCKING FOR PAIN OF COMPRESSION FRACTURE OF LUMBAR VERTEBRA

Objective To compare radiofrequency of posterior ramus of lumbar nerve（PROLN） with nerve block in terms of short-and long-term analgesic effect and its safety for elderly with painful compression fracture of lumbar vertebra. Methods A total of 60 senior patients with osteoporotic compression vertebral fracture were equally randomized to group A（observation group） and group B（control group）.Radiofrequency of PROLN was offered to patients in group A,and nerve block of PROLN to those in group B,the therapeutic efficacy was assessed by visual analogue scale（VAS） and ODI at one day before the treatment and one day,five days,three and six months after the intervention. Results Compared with before treatment,the score of VAS and ODI in group A,at each time point after treatment descended obviously,the differences being significant（F=23.770,414.821;q=9.969-46.117;P〈0.01）;and in group B,one and five days after treatment,the score of VAS and ODI decreased markedly（F=21.004,354.325;q=5.064-40.039;P〈0.05）.The differences of VAS and ODI at one day and five days after therapy between groups A and B were not significant（P〈0.05）,while after three and six months,the score of VAS and ODI in group A decreased more obviously than that in group B（t=4.814-26.612,P〈0.05）. Conclusion The long-term analgesia of radiofrequency therapy of PROLN is superior to nerve block for elderly patients with painful compression fracture of lumbar vertebra.