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1、颈椎脊神经后支射频热凝术有效性的随机对照研究廖翔蒋劲熊东林张强肖礼祖郑虎山沙彤梁豪文罗裕辉(深圳市第六人民医院疼痛科,深圳518052)摘要目的:通过随机对照研究,评价射频热凝术治疗颈椎脊神经后支诱发慢性颈肩痛的有效性。方法:自2005年12月至2008年12月共127名患者纳入研究,所有病人均经诊断性颈椎脊神经后支阻滞有效,明确为颈椎脊神经后支诱发慢性颈肩痛。随后随机分为两组,A组采用DSA影像引导下脊神经后支射频热凝术治疗,B组采用口服药物保守治疗,随访期2年。利用视觉模拟评分法(VisualAnalogScores,VAS)进行治疗前后疗效评定。以VAS评分
2、小于治疗前的50%视为优良疗效,反之视为疗效不佳。利用Kaplan-Meier生存曲线与Log-Rank检验进行两组疗效对比。记录手术并发症与用药副作用。结果:A组VAS评分回到术前50%的平均时间是217天,B组为27天(P<0.01)。在第27周(治疗后200天),A组36名患者完全无痛,B组为1名。A组术后疗效优良率显著高于B组(P<0.01)。B组3例病人出现胃部不适,纳差,经对症治疗后消失。A组9例病人术后出现神经支配区域的皮肤麻木,无感染及脊神经前支、椎动脉损伤等并发症。结论:对于颈椎脊神经后支诱发慢性颈肩痛,颈椎脊神经后支射频热凝术相比保守治疗,能够
3、更有效的长期缓解疼痛,且操作安全,副作用很少。关键词颈椎脊神经后支;射频热凝;随机对照研究PERCUTANEOUSRADIOFREQUENCYNEUROTOMYFORCHRONICCERVICALZYGAPO-PHYSEALJOINTPAIN:ARANDOMIZEDCONTROLLEDTRIALLIAOXiang,JIANGJin,XIONGDong-Lin,ZHANGQiang,XIAOLi-Zu,ZHENGHu-Shan,SHATong,LiangHao-Wen,LUOYu-Hui(DepartmentofPainMedicine,theSixthPeople
4、’sHospitalinShenzhen,Shenzhen518052)AbstractObjective:Tocomparetheefficacyofpercutaneousradiofrequencythermocoagulationofthemedialbranchesofthecervicaldorsalramiandconservativetreatmentinpatientswithchronicneckandshoulderpainthrougharandomizedcontrolledtrials.Methods:FromDec.2005toDec
5、.2008,127patientswithchronicneckandshoulderpainwereenrolledintothisstudyandwererandomlydividedintotwogroups.Allpatientshadadiagnosisofchronicneckandshoulderpianestablishedbycontrolledmedialbranchblocks.UndertheguidanceofDSA,groupAweretreatedwithpercutaneousradiofrequencytherm-ocoagula
6、tionofthemedialbranchesofthecervicaldorsalramivialateralapproach.GroupBweretreatedwithNSAIDsdrug.TheefficacyincludingVASscoresandKaplan-Meiercurveofthetreatmentfrombothgroupswererecordedtillthe24thmonthandanalyzedforcomparison.Sideeffectsandcomplicationswererecorded.Results:Themediant
7、imethatelapsedbeforethepainreturntoatleast50%ofthepreoperativelevelwas217daysinthegroupAand27daysinthegroupB(P<0.01).At27weeks,36patientsinthegroupAand1patientinthegroupBwerefreeofpain.9patientsinthegroupAhadnumbnessintheterritoryofthetreatednerves,3patientsinthegroupBhadgastralgiaand
8、anore
