CT引导下低温等离子射频消融术治疗颈神经根阻滞阳性颈源性胸痛患者的近期疗效

Short-term efficacy of CT guided percutaneous low-temperature plasma radiofrequency ablation in patients with cervicogenic chest pain after positive cervical nerve root block*

摘要:

目的 评价 CT 引导下颈椎间盘低温等离子射频消融术治疗超声引导下颈神经根阻滞试验阳性颈源性胸痛患者的近期临床效果。方法 选取 2019 年 10月～2022年10月秦皇岛市第一医院疼痛科超声引导下颈神经根阻滞试验阳性颈源性胸痛患者45例，所有患者行CT引导定位颈椎间盘低温等离子射频消融术。记录患者术前、术后 1 周、1月、3月和6月的疼痛数字评分（NRS）、颈椎功能障碍指数（NDI）评分及口服镇痛药物情况；术后1月、3月和 6 月依据改良Macnab 标准评价疗效；并记录术中及术后不良反应发生情况。 结果 与术前比较，术后 1 周、1月、3月、6月的 NRS 评分明显降低，差异有统计学意义（P＜0.05）；但术后各时点NRS评分差异无统计学意义（P?0.05）；术后NDI评分亦明显下降，与术前比较差异有统计学意义（P＜0.05）；术后口服镇痛药物患者比例明显减少（P＜0.05）；术后1月、3月和6月改良Macnab 标准优良率分别为：93.3%、91.1%和88.8%；所有患者均无神经损伤、血管损伤、血肿和感染等不良反应发生。 结论 CT引导下颈椎间盘低温等离子射频消融术治疗颈源性胸痛安全、有效，术前行超声引导下颈神经根阻滞试验有助于明确责任间盘，提高诊断正确率和治疗效果，值得临床借鉴。

Abstract:

Objective: To evaluate the short-term clinical effect of CT-guided low-temperature plasma radiofrequency ablation in patients with cervicogenic chest pain under a positive ultrasound-guided cervical nerve root block test. Method: From October 2019 to October 2022, 45 patients with cervicogenic chest pain who were positive for ultrasound-guided cervical nerve root block test were selected from the Pain Management Department of the First Hospital of Qinhuangdao. All patients underwent CT-guided low-temperature plasma radiofrequency ablation of cervical intervertebral discs. The numerical rating score (NRS), cervical dysfunction index (NDI) score, and oral analgesic medication cases before and 1 week, 1 month, 3 months, and 6 months after the operation were recorded. The therapeutic effect was evaluated using modified Macnab criteria at 1 month, 3 months, and 6 months post-operation, and the occurrence of adverse reactions was also recorded. Results: Compared with preoperative results, the chest pain NRS scores significantly decreased at 1 week, 1 month, 3 months, and 6 months after the operation, with a statistically significant difference (P < 0.05), however, there was no statistically significant difference in NRS scores at each time point post-operation (P > 0.05); The postoperative NDI score also significantly decreased, with a statistically significant difference compared to pre-operation (P < 0.05); The proportion of postoperative patients taking oral analgesics significantly decreased ( P < 0.05); The excellent and good rates of the modified Macnab criteria at 1 month, 3 months, and 6 months post-operation were 93.3%, 91.1%, and 88.8%, respectively; All patients had no adverse reactions such as nerve injury, vascular injury, hematoma, or infection. Conclusion: CT-guided low-temperature plasma radiofrequency ablation is a safe and effective treatment for cervicogenic chest pain. Preoperative ultrasound-guided cervical nerve root block test contributes to clarifying the responsibility of intervertebral disc, improves diagnostic accuracy and treatment effectiveness, and is worthy of clinical reference.