阴部神经联合骶神经脉冲射频治疗阴部神经痛:一项随机对照研究

Combined Pulsed Radiofrequency of Pudendal and Sacral Nerves for Pudendal Neuralgia: A Randomized Controlled Trial

摘要:

目的:评估阴部神经联合骶神经脉冲射频治疗阴部神经痛的疗效。方法: 招募从2024年1月至2025年1月在北京大学人民医院接受射频治疗的女性阴部神经痛患者66例。随机分为两组:PN PRF组(n=33):患者只接受阴部神经脉冲射频；PN+S3 PRF组(n=33):患者接受阴部神经+S3神经脉冲射频。比较两组患者在术后1月、3月、6月和12月时的疼痛程度(VAS)、疼痛总体改善程度(OIP)、医院焦虑抑郁评分(焦虑:HADS-A；抑郁:HADS-D)、疼痛灾难化程度(PCS)和不良反应等指标。结果:术后1月、3月、6月和12月,两组的VAS评分均低于术前(P < 0.05)。术后1月,PN+S3 PRF组的VAS评分高于PN PRF组(P<0.05),而OIP评分低于PN PRF组(P<0.05)；术后3、6月,两组VAS及OIP评分差异均无统计学意义；术后12月,PN+S3 PRF组VAS评分低于PN PRF组(3.15±1.57 vs. 4.34±1.71,P<0.05),OIP评分高于PN PRF组(70.0%±19.1% vs. 55.2%±25.3%,P<0.05)。术后各时间点,两组的HAD评分和PCS评分均低于术前(P < 0.05)。术后12月,PN+S3 PRF组的HADS-A(4.00±2.10)、HADS-D(3.15±2.01)及PCS(14.10±9.44)评分均显著低于PN PRF组(6.15±3.13, 5.44±3.41, 20.76±11.37)(P< 0.05)。在术后所有时间点两组均未观察到严重并发症。结论:对于女性阴部神经痛患者,与单纯阴部神经PRF相比,联合S3神经PRF在术后12个月时可提供更优的疼痛控制效果,并显著改善焦虑、抑郁情绪及疼痛灾难化认知。

Abstract:

Objectives: To assess the therapeutic efficacy of combined pudendal and sacral nerve pulsed radiofrequency for pudendal neuralgia. Methods: Sixty-six female patients with pudendal neuralgia who underwent radiofrequency treatment at Peking University People"s Hospital between January 2024 and January 2025 were enrolled. Participants were randomly assigned to two groups: the PN PRF group () received pudendal nerve PRF alone, and the PN+S3 PRF group (n=33) received combined pudendal and S3 nerve PRF. Outcome measures including Visual Analog Scale (VAS), Overall Improvement in Pain (OIP), Hospital Anxiety and Depression Scale (HADS-A and HADS-D), Pain Catastrophizing Scale (PCS), and adverse events were assessed at 1, 3, 6, and 12 months post-procedure. Results: At 1, 3, 6, and 12 months following the procedure, VAS scores were significantly reduced from baseline in both groups (P < 0.05). At 1 month, the PN+S3 PRF group demonstrated higher VAS scores (P < 0.05) and lower OIP scores (P < 0.05) compared with the PN PRF group. No significant between-group differences were observed in VAS or OIP scores at 3 and 6 months. At 12 months, the PN+S3 PRF group exhibited lower VAS scores (3.15 ± 1.57 vs. 4.34 ± 1.71, P < 0.05) and higher OIP scores (70.0% ± 19.1% vs. 55.2% ± 25.3%, P < 0.05) than the PN PRF group. HADS and PCS scores were significantly decreased from baseline at all postoperative time points in both groups (P < 0.05). At 12 months, the PN+S3 PRF group showed significantly lower HADS-A (4.00 ± 2.10), HADS-D (3.15 ± 2.01), and PCS (14.10 ± 9.44) scores compared with the PN PRF group (6.15 ± 3.13, 5.44 ± 3.41, and 20.76 ± 11.37, respectively; P < 0.05). No serious complications were observed at any postoperative time point in either group. Conclusions:For female patients with pudendal neuralgia, combined S3 nerve PRF provides superior pain control at 12 months post-procedure compared with pudendal nerve PRF alone, with significant improvements in anxiety, depression, and pain catastrophizing.