弧刃针刀联合神经阻滞治疗枕大神经痛的临床研究*

Clinical study on arc edge needle scalpel combined nerve block in the treatment of greater occipital neuralgia

摘要:

目的：评估弧刃针刀 (arc edge needle scalpel, AENS) 联合C2水平超声引导枕大神经阻滞 (greater occipital nerve block, GONB) 治疗枕大神经痛的临床疗效。方法：回顾性分析84例枕大神经痛患者的病历资料,按照治疗方案的不同将其分为对照组和联合组。对照组采用C2水平GONB,联合组采用AENS联合C2水平GONB。分别于治疗前和治疗后7天、1月、3月对患者进行疼痛数字分级评分法评分 (numerical rating scale, NRS)、头痛影响测评量表-6 (Headache Impact Test-6, HIT-6) 以及整体感知疗效 (global perceived effect, GPE) 随访并进行临床差异性分析。结果：治疗后7天、1月时联合组NRS、HIT-6及GPE评分联合组和对照组分别为(1.5± 0.2 vs. 2.5± 0.4、1.8 ± 0.3 vs. 2.8± 0.4)、(1.8 ± 0.2 vs. 2.8 ± 0.4、2.1 ± 0.3 vs. 3.9 ± 0.5)、(6.0 ± 0.1 vs. 5.5 ± 0.2、5.9 ± 0.1 vs. 5.4 ± 0.2) (P < 0.05), 3月时(1.7 ± 0.3 vs. 3.1 ± 0.4)、(2.2 ± 0.4 vs. 4.5 ± 0.6)、(5.8 ± 0.1 vs. 5.1 ± 0.2)降低更为显著 (P < 0.01), 两组均未观察到严重不良反应。结论：AENS联合C2水平GONB能够明显减轻枕大神经痛,3个月随访疗效稳定,较单独GONB更有效。

Abstract:

Objective: To evaluate the clinical efficacy of arc edge needle scalpel combined with C2 level ultrasound-guided greater occipital nerve block in the treatment of greater occipital neuralgia. Methods: Eighty-four patients with greater occipital neuralgia were retrospectively analyzed. According to the different treatment options, they were divided into the control group and the combination group. The control group was treated with C2 level ultrasound-guided greater occipital nerve block (GONB), and the combined group was treated with arc edge needle scalpel (AENS) combined with C2 level ultrasound-guided GONB. Numerical rating scale (NRS), Headache Impact Test-6 (HIT-6) and global perceived effect (GPE) were followed up and analyzed before treatment and the 7th ^{day, the 1}st months and the 3rd ^month after treatment. Results: At the 7th days and the 1st month after treatment, the NRS, HIT-6 and GPE scores of the combination group and the control group were (1.5± 0.2 vs. 2.5± 0.4、1.8 ± 0.3 vs. 2.8± 0.4), (1.8 ± 0.2 vs. 2.8 ± 0.4、2.1 ± 0.3 vs. 3.9 ± 0.5), (6.0 ± 0.1 vs. 5.5 ± 0.2、5.9 ± 0.1 vs. 5.4 ± 0.2), (P < 0.05), respectively. At the 3rd months the NRS, HIT-6 and GPE scores of the two groups were 1.7 ± 0.3 vs. 3.1 ± 0.4, 2.2 ± 0.4 vs. 4.5 ± 0.6, and 5.8 ± 0.1 vs. 5.1 ± 0.2, respectively. The combined group decreased more significant (P < 0.01). No serious adverse reactions were observed in both groups. Conclusions: AENS combined C2 level GONB can significantly reduce greater occipital neuralgia, and the curative effect is stable at the 3rd months follow-up, which is more effective than GONB alone.