低温等离子消融术和温控射频热凝术治疗脊神经后支源性腰痛的临床疗效及安全性比较

A COMPARISON OF LOW-TEMPERATURE PLASMA RADIOFREQUENCY ABLATION AND TEMPERATURE-CONTROLLED RADIOFREQUENCY THERMOCOAGULATION IN THE TREATMENT OF LOW BACK PAIN CAUSED BY MEDIAL BRANCH OF THE SPINAL DORSAL RAMUS

摘要:

目的：回顾性比较低温等离子消融术(Low-temperature plasma radiofrequency ablation,CA)和射频热凝术(Radiofrequency thermocoagulation,RF)治疗脊神经后支源性腰痛的短期及长期临床疗效和安全性。方法：2018年9月至2019年10月在中日友好医院疼痛科接受介入手术治疗的65名脊神经后支源性腰痛住院患者按手术方式分为低温等离子消融术组(CA组)和射频热凝术组(RF组)。CA组(n=44)只接受了脊神经后内侧支低温等离子消融术,RF组(n=21)只接受了脊神经后内侧支射频热凝毁损术。分别于术前、术后第1天、2周、1个月、3个月、6个月和12个月对患者数字评分法(Numerical rating scale, NRS)评分、改良MacNab标准,手术相关并发症和患者满意度进行随访,并进行组内及组间差异性分析。结果：两组患者术前NRS评分无统计学差异(P=0.785＞0.05)。两组患者术后第1天、2周、1、3、6、12个月的NRS评分均低于术前,差异有统计学意义(P＝0.000＜0.001)。组间比较,术后第1天CA组NRS评分低于RF组,差异有统计学意义(P=0.019＜0.05)。术后2周至12月CA组NRS评分均低于RF组,差异无统计学意义。根据改良MacNab标准,CA组在术后第1天功能评分为优和/或良和/或可的患者比例(65.9%)明显高于RF组(38.1%),差异有统计学意义(P = 0.082＜0.05)。手术相关并发症比较发现,两组差异无统计学意义(P＝1.000＞0.05)。结论：低温等离子消融术或射频热凝术都可以有效治疗脊神经后支源性腰痛,两种方法均能获得短期及为期12个月的长期疗效,而两种治疗方法的长期疗效和安全性之间没有差异。

Abstract:

Objective: To retrospectively compare the short-term and long-term clinical outcomes and safety of low-temperature plasma radiofrequency ablation (Coblation) and radiofrequency thermocoagulation in the treatment of Low Back Pain caused by Medial Branch of the Spinal Dorsal Ramus. Methods：Between September 2018 and October 2019, 65 inpatients who underwent low-temperature plasma radiofrequency ablation and radiofrequency thermocoagulation surgery for Low Back Pain cased by Medial Branch of the Spinal Dorsal Ramus in the Pain Department of the China-Japan Friendship Hospital were divided into the low-temperature plasma radiofrequency ablation (Coblation) (CA group, n=44) and radiofrequency thermocoagulation group (RF group,n=21).At follow-up examinations, data were recorded at pre-operation, the first day post-operation, 2 weeks, 1 month, 3 months, 6 months and 12 months. The Numerical rating scale (NRS) scores、Modified MacNab criteria、postoperative complications and patient satisfaction survey were used to evaluate the clinical results .The intra- and inter-group differences were analyzed. Results: There was no difference between the two groups in preoperative NRS scores(P=0.785＞0.05).NRS scores, in all other postoperative time points were significantly lower than preoperative values each in both groups (P＝0.000＜0.001).The NRS score of CA group was lower than that of RF group after the day of operation, and the difference was statistically significant (P=0.019<0.05). The NRS scores of CA group were lower in comparison to those of RF group from 2 weeks to 12 months after operation, and the difference was not statistically significant. According to the modified MacNab criteria, the proportion of patients (65. 9%) with excellent and/or good and/or fair functional scores in the CA group was significantly higher than that in the RF group (38.1%) on the first day after surgery, and the difference was statistically significant (P = 0.082 < 0.05).The MacNab scores of 1-year follow-up in the RF group were higher than that in the control group (P < 0.05). The incidence of complications in the RF group was significantly less than that in the control group (P < 0.05).Comparisons of surgical-related complications showed that there was no significant difference between the two groups (P=1.000>0.05). Conclusion: Low-temperature plasma radiofrequency ablation (Coblation) or radiofrequency thermocoagulation group can effectively treat low back pain caused by Medial Branch of the Spinal dorsal ramus, and both methods can achieve short-term and long-term efficacy for 12 months, while there is no significant difference in the long-term efficacy and safety between the two treatment regimens.