Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain
Percutaneous radio-frequency neurotomy for chronic cervical zygapophyseal-joint pain
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DOI：
10.1056/nejm199612053352302
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发表时间：
1996-12-05
影响因子：
158.5
通讯作者：
Bogduk, N
中科院分区：
文献类型：
--
作者：
Lord, SM;Barnsley, L;Bogduk, N
背景颈部关节突关节慢性疼痛是挥鞭样损伤后常见的问题，但治疗困难。经皮射频神经切断术可以通过使支配疼痛关节的神经变性来缓解疼痛，但这种治疗的疗效尚未确定。我们比较了经皮放射治疗频率神经切开术，其中进行多个损伤，并且将进行损伤的电极的温度升高到80摄氏度，对照治疗使用相同的程序，除了我们研究了24名在车祸后有一个或多个颈椎关节突关节疼痛的患者（9名男性和15名女性;平均年龄，43岁）（疼痛的中位持续时间，34个月）。通过使用双盲、安慰剂对照的局部麻醉，确定了他们疼痛的来源。12名患者接受了每种治疗。患者随后进行电话采访和诊所访问，直到他们报告说，他们的疼痛已经恢复到50%的术前level.Results的前疼痛恢复到至少50%的术前level. Results的中位数时间为263天，在积极治疗组和8天，在对照组（P = 0.04）。在27周时，活性治疗组的7名患者和对照组的1名患者没有疼痛。积极治疗组中有5名患者在接受治疗的神经区域出现麻木，但没有人认为这是令人不安的。结论对于经双盲、安慰剂对照局部麻醉确诊的慢性颈部关节突关节疼痛患者，经皮射频神经切开术联合多处靶神经病变可以提供持久的缓解。(C)1996年，马萨诸塞州医学会。
Background Chronic pain in the cervical zygapophyseal joints is a common problem after whiplash injury, but treatment is difficult. Percutaneous radiofrequency neurotomy can relieve the pain by denaturing the nerves innervating the painful joint, but the efficacy of this treatment has not been established.Methods In a randomized, double-blind trial, we compared percutaneous radio-frequency neurotomy in which multiple lesions were made and the temperature of the electrode making the lesions was raised to 80 degrees C with a control treatment using an identical procedure except that the radio-frequency current was not turned on. We studied 24 patients (9 men and 15 women; mean age, 43 years) who had pain in one or more cervical zygapophyseal joints after an automobile accident (median duration of pain, 34 months). The source of their pain had been identified with the use of double-blind, placebo-controlled local anesthesia. Twelve patients received each treatment. The patients were followed by telephone interviews and clinic visits until they reported that their pain had returned to 50 percent of the preoperative level.Results The median time that elapsed before the pain returned to at least 50 percent of the preoperative level was 263 days in the active-treatment group and 8 days in the control group (P = 0.04). At 27 weeks, seven patients in the active-treatment group and one patient in the control group were free of pain. Five patients in the active-treatment group had numbness in the territory of the treated nerves, but none considered it troubling.Conclusions In patients with chronic cervical zygapophyseal-joint pain confirmed with double-blind, placebo-controlled local anesthesia, percutaneous radio-frequency neurotomy with multiple lesions of target nerves can provide lasting relief. (C) 1996, Massachusetts Medical Society.