双电极短时程脊髓电刺激治疗带状疱疹后神经痛的应用研究*

A clinical study on the treatment of postherpetic neuralgia with short-term spinal cord stimulation with double electrodes

摘要:

目的：探讨双电极短时程脊髓电刺激治疗带状疱疹后神经痛的有效性和安全性。方法：选择2022年3月至2024年2月菏泽市立医院和广西医科大学第二附属医院就诊病程在3月内的带状疱疹后神经痛病人80例,选择短时程脊髓电刺激治疗,采用随机数字表法分为单电极组(single wire electrodeSlead,即S组)和双电极组(double wire electrodeSlead,即D组),每组40例。观察手术时间、异感覆盖范围、治疗时间、治疗并发症例数(神经损伤、硬膜外血肿、感染、脑脊液漏、电极移位)和术后半年有效率。比较术前、治疗结束时、术后1月和术后6月的疼痛数字评分法(numerical rating scale, NRS)评分、匹兹堡睡眠质量指数 (Pittsburg sleep quality index, PSQI)。结果：两组术后各时点NRS评分和PSQI评分均小于术前(P < 0.05),术后D组各时点NRS评分和PSQI评分均小于S组(P < 0.05)。D组手术总时间长于S组(P < 0.05),D组异感覆盖范围大于S组(P < 0.05),两组治疗天数和治疗并发症比较差异无统计学意义(P ?0.05)。D组术后半年有效率大于S组(P < 0.05)。结论：双电极短时程脊髓电刺激治疗带状疱疹后神经痛明显增加异感覆盖范围,疗效优于单电极脊髓电刺激,可作为短时程脊髓电刺激治疗的新方法。

Abstract:

Objective: To investigate the efficacy and safety of short-term spinal cord stimulation(stSCS)with double electrodes on the treatment of postherpetic neuralgia(PHN). Methods: 80 patients who were suffering from postherpetic neuralgia were randomly devided into single electrode treatment group (group S) and double electrode treatment group (group D),with 40 cases in each group. Patients in group D and group S visited either Heze Municipal Hospital or the Second Affiliated Hospital of Guangxi Medical University between March 2022 and February 2024.The time of operation, the coverage of alloesthesia, the number of treatment days, the number of treatment complications (nerve injury, epidural hematoma, infection, electrode rupture) and the effective rate of six months after operation were observed. Numerical rating scale (NRS) score and Pittsburgh sleep quality index (PSQI) were compared before surgery, at the end of treatment, 1 month after surgery and 6 months after surgery. Results: The NRS scores and PSQI scores of the two groups were lower than that before surgery (P < 0.05). And after surgery, the NRS scores and PSQI scores in group D were lower than that in group S (P < 0.05). The total operation time in group D was longer than that in group S (P < 0.05), and the coverage of different sensation of group D was larger than that of group S (P < 0.05). There was no statistical significance in treatment days and complications between the two groups (P ?0.05). The half-year postoperative effective rate in group D was higher than that in group S (P < 0.05).Conclusion: The treatment of PHN with double-electrode stSCS can significantly increase the coverage of alloesthesia. And the efficacy is better than that of single electrode SCS, which can be used as a new method of stSCS.