超声引导下选择性神经根阻滞联合脉冲射频治疗神经根型颈椎病

Treatment of nerve root block and pulsed radiofrequency on cervical spondylotic radiculopathy guided by ultrasound

摘要:

目的：探讨超声引导下选择性神经根脉冲射频联合药物治疗神经根型颈椎病的有效性及安全性。方法：回顾分析2017年1月至2020年6月北京大学第三医院疼痛科住院的46例神经根型颈椎病病人临床资料，超声引导下行颈椎神经根脉冲射频联合药物治疗，采用疼痛数字评分法 (numeric rating scale, NRS)进行疼痛程度评分，并进行临床治疗效果评价以及记录并发症的发生情况。结果：41例病人可清晰显示C4-8神经根，5例病人通过射频治疗仪定位确认，46例病人均100%穿刺顺利，治疗前及术后1周、4周、12周、24周NRS评分分别为6.8±1.0、3.0±0.8、3.1±0.8、2.8±0.7、2.7±0.8，术后各时点NRS评分与术前相比较差异有统计学意义（P < 0.01）。术后1周、4周、12周、24周治疗的优良率分别为89.1%、80.4%、80.4%、76.1%。所有病人均无神经损伤等并发症。结论：超声引导下选择性颈椎神经根阻滞联合脉冲射频治疗神经根型颈椎病效果可靠，安全性高，无明显不良反应。

Abstract:

Objective: To evaluate the clinical effects and safety of ultrasound-guided nerve root block and pulsed radiofrequency on cervical spondylotic radiculopathy. Methods: A total of 46 patients with cervical spondylotic radiculopathy in department of pain medicine,Peking University Third Hospital from January 2017 to June 2020, underwent ultrasound-guided selective cervical nerve block and pulsed radiofrequency according to involved cervical nerve root segments. Numeric rating scale(NRS) and therapeutic effect was recorded before treatment and 1 week, 4 weeks, 12 weeks and 24 weeks after treatment. The therapeutic effect was evaluated according to Odom criteria. The incidence of adverse reactions was also recorded after treatment. Results: The cervical nerve root was showed clearly in 41 patients, however, 5 patients had to be confirmed by radio frequency therapy device positioning. The percentage of successful rate is 100%. The NRS score of preoperation and 1 week, 4 weeks, 12 weeks, and 24 weeks after treatment was 6.8±1.0, 3.0±0.8, 3.1±0.8, 2.8±0.7 and 2.7±0.8, respectively. Scores of NRS after treatment were significantly lower than those of before treatment ( P＜0.01)．According to the Odom criteria，the overall excellent and good rates 1 week,4 weeks,12 weeks and 24 weeks after treatment were 89.1%, 80.4%, 80.4% and 76.1% respectively. There was no operation related nerve injury and other complications among all patients. Conclusion: Ultrasound-guided selective cervical nerve root block and pulsed radiofrequency is a safe and effective method for the treatment of patients with cervical spondylotic radiculopathy．