【摘要】 目的:探索一种腰骶部脊神经后根脉冲射频的穿刺径路,观察脉冲射频治疗根性腰腿痛的效果。方法:选择2003/2005深圳市南山人民医院疼痛诊疗中心收治的根性腰腿痛的患者68例。根据小关节内侧缘穿刺是抵达侧隐窝的最短距离,以及腰骶部脊神经后根在椎管内的解剖学特点,选择小关节内侧缘入路寻找脊神经后根。经精确测量,准确定位后(部分患者在数字减影血管造影或CT引导下)用射频针进行穿刺,到达侧隐窝后开启射频机,通过电刺激诱发出病变区的疼痛,判断针尖靠近脊神经后根时进行脉冲射频治疗,采用脉冲射频模式(2次/s,20ms/次,维持42℃,120s的周期)进行治疗,持续两个周期。术后观察不良事件,术前和术后2个月评估目测类比评分,计算疼痛缓解率。结果:68例患者均进入结果分析。①68例穿刺成功,3例造影患者显示造影剂分布于侧隐窝,2例CT下穿刺显示针尖靠近神经根。②术后2个月疼痛缓解率达50%的患者49例(72%),未发现肌力减退、皮肤的麻木等不良事件。结论:精确测量、准确定位后经小关节内缘穿刺入路抵达脊神经后根的方法是可行的,腰骶部背根神经(节)的脉冲射频治疗根性腰腿痛的近期疗效是肯定和明显的。更多还原

【Abstract】 AIM: To probe an approach to the lumbosacral dorsal root of spinal nerves in the procedure of pulsed radiofrequency and observe the effect of pulsed radiofrequency on lumbosacral backle pain. METHODS: Totally 68 patients with lumbosacral backle pain who were diagnosed at Center of Pain Management, Nanshan People’s Hospital from 2003 to 2005. According to the shortest distance (medial border puncturation of small articular) of reaching lateral recessus process and the anatomic characteristics of lumbosacral dorsal root of spinal nerves, medial border approach of small articular process was selected for finding root of spinal nerves. After precision measurement and exact localization (some patients with digital subtraction angiography or CT), puncturation was performed with radiofrequency needle. Radiofrequency machine was used after reaching lateral recessus. Ache in diseased region was induced by electric stimulation. Pulsed radiofrequency treatment was conducted when the needle tip approached to root of spinal nerves. Pulsed radiofrequency mode was applied (2 times/s, 20 ms every time, at 42 ℃, 120 s as a cycle) for 2 cycles. Side event was observed after operation. Visual Analog Scale (VAS) was assessed before and after operation for 2 months. Pain relief rate was calculated. RESULTS: A total of 68 patients were involved in the result analysis. ①This approach was used in 68 patients with successful procedures. The diagnostic opaque was distributed at lateral recessus in 3 visualization patients. Needle tip approached to nerve root in 2 patients with CT. ②The pain relief rate reached to 50% in 49 patients (72%) at month 2 after operation. There was no side event such as decrescence of muscle force, anaesthesia of skin and so on. CONCLUSION: The approach to the lumbosacral dorsal root of spinal nerves from the medial margin of the small articular precesses after precision measurement and exact localization is feasible. Curative effect of pulsed radiofrequency at lumbosacral dorsal root nerves for lumbosacral backle pain is sure and significant in the near future.更多还原