腰神经内侧支不同温度射频热凝治疗慢性腰痛疗效分析

Clinical effect of lumbar nerve medial branch radiofrequency thermocoagulation at different temperatures for chronic low back pain

摘要:

目的：观察腰神经内侧支75℃和90℃射频热凝对慢性腰痛病人疼痛及运动功能改善情况。方法：采用前瞻性随机对照研究，选取2021年1月至2022年1月中日友好医院疼痛科符合纳入标准腰痛病人200例，按随机数字法分为75℃组（n = 100）和90℃组（n = 100），治疗后1个月、3个月和6个月评价主要终点指标疼痛数字评分法 (numerical rating scale, NRS) 评分（0~10分）以及疼痛降低2分以上病人比例（临床显著差异性最小差值），次要终点指标腰椎Oswestry功能障碍指数以及腰痛ODI评分 (Oswestry dysfunction index, ODI)降低15分以上病人比例。结果： NRS评分变化第3个月和6个月75℃组和90℃组相比差异有统计学意义（-2.1 vs. -2.8, -2.0 vs. -2.8，P < 0.05），第1、3和第6个月90℃组NRS评分降低≥2分病人比例更高（71.9% vs. 81.4%，71.9% vs. 80.4%，72.5% vs. 82.6%，P < 0.05）。ODI变化第3个月和6个月75℃组和90℃组相比差异有显著统计学意义（-13.6 vs. -18.6, -11.1 vs. -17.7, P < 0.001），第1、3和第6个月90℃组ODI评分降低≥ 15分比例更高（68.8% vs. 78.4%，64.0% vs. 73.9%，55.0% vs. 70.0%，P < 0.05）。结论：腰神经内侧支射频热凝90℃比75℃效果更显著。

Abstract:

Objective: To observe the effect of lumbar nerve medial branch radiofrequency thermocoagulation at 75℃ and 90℃ on pain and motor function in patients with chronic low back pain. Methods: A prospective randomized controlled study was conducted. From January 2021 to January 2022, patients with low back pain who met the inclusion criteria in the Pain Department of China- Japanese Friendship Hospital were selected and randomly divided into 75 ℃ group (n = 100) and 90 ℃ group (n = 100) The primary endpoint was NRS (Numerical rating scale) pain score (0-10 points) and the proportion of patients with pain reduction of more than 2 points (minimum difference of clinical significant difference) were evaluated 1 month, 3 months and 6 months after treatment. The secondary endpoint was lumbar ODI (Oswestry dysfunction index) score and the proportion of patients with ODI reduction of more than 15 points. Results: Two hundred patients met the inclusion criteria and were randomly divided into 75℃ group (n=100) and 90℃ group (n=100). There was a statistically significant difference of NRS change (-2.1 vs. -2.8, -2.0 vs. -2.8, p<0.05) between the 75℃ group and the 90℃ group in the 3rd and 6th months. The proportion of patients with NRS reduction ≥ 2 points in the 90℃ group was higher (71.9% vs. 81.4%，71.9% vs. 80.4%, 72.5% vs. 82.6%, p<0.05) in the 1st, 3rd and 6th months. There was a statistically significant difference of ODI score change between the 75℃ group and the 90℃ group in the 3rd and 6th months (-13.6 vs. - 18.6, -11.1 vs. - 17.7, p< 0.001). The proportion of ODI reduction ≥ 15 points in the 90℃ group was higher (68.8% vs. 78.4%，64.0% vs. 73.9%, 55.0% vs. 70.0%, p<0.05) in the 1st, 3rd and 6th months. Conclusion: Radiofrequency thermocoagulation of lumbar nerve medial branch at 90℃ is more effective than 75℃.