摘要
目的评价CT引导下经皮穿刺颈脊神经根射频热凝术治疗颈枕部顽固性带状疱疹后神经痛(PHN)的效果。方法收集2016年1月至2019年6月宁波市第一医院疼痛科和嘉兴学院附属医院疼痛科诊治的颈枕部PHN患者27例,年龄≥18岁,性别不限,视觉模拟评分(VAS)>5分。患者患侧向上侧卧于CT台上,拍摄定位像后用脊柱模式层厚3 mm对上颈段行轴位扫描,按设计的穿刺路径将射频穿刺针穿刺至相应椎间孔靶点位置,电生理测试确认位置无误后行90℃、180 s标准射频热凝治疗。术后第2日及1、3、6、12个月时记录VAS评分,评价疗效并观察并发症与不良反应情况。结果27例PHN患者均在CT定位引导下穿刺至相应颈椎间孔,完成射频热凝治疗。患者原疼痛区皮肤感觉减退,触诱发痛基本消失,达优效者16例,良效和可效者分别为8例和3例,随访期间未见复发或加重病例。结论CT引导下经皮穿刺颈脊神经根射频热凝术可有效治疗顽固性颈枕部带状疱疹后神经痛。
Objective To explore the effects of radiofrequency ablation in cervical spinal nerve root under CT guided percutaneous puncture on the intractable postherpetic neuralgia(PHN)in cervical and occipital region.Methods Twenty-seven patients with PHN in the cervical and occipital region,aged≥18 years old,both sexes,VAS>5,from Department of Pain Medicine,the First Hospital of Ningbo and the Affiliated Hospital of Jiaxing University,were collected in this study.The patients lied on the CT table diseased side up.After taking the location image,axial scanning was performed on the upper cervical segment with the thickness of 3 mm of spine model layer.Then the puncture path was designed,the radiofrequency puncture needle was punctured to the corresponding intervertebral foramen according to the designed puncture path,and radiofrequency ablation was performed at 90℃,180 s after the location was confirmed by the electrophysiological test.VAS,the effects and adverse reactions were recorded at 2 days and 1,3,6,12 months after the treatment.Results All of 27 patients with PHN were punctured to the corresponding cervical intervertebral foramen under the guidance of CT positioning.After radiofrequency thermocoagulation the skin sensation in the original pain area decreased,and the allodynia basically disappeared.There were 16 cases with excellent effects,8 cases with good effects,3 cases with acceptable effects.No recurrence or exacerbation was found during follow-up.Conclusion CT guided percutaneous radiofrequency ablation of cervical spinal nerve root can effectively treat patients with intractable cervical and occipital PHN.
作者
林慧丹
黄冰
曹刚
金冠军
杨赵栋
张利
费勇
谢可越
Lin Huidan;Huang Bing;Cao Gang;Jin Guanjun;Yang Zhaodong;Zhang Li;Fei Yong;Xie Keyue(Department of Pain Medicine,the First Hospital of Ningbo,Ningbo City,Zhejiang Province 315000,China;Department of Pain Medicine,the Affiliated Hospital of Jiaxing University,Jiaxing City,Zhejiang Province 314000,China)
出处
《中华疼痛学杂志》
2020年第3期214-219,共6页
Chinese Journal Of Painology
