[The efficacy of ultrasound-guided spinal nerve posterior ramus pulsed radiofrequency treatment for aged lower back post-herpetic neuralgia].

Objective: To evaluate the efficacy of ultrasound-guided spinal nerve posterior ramus pulsed radiofrequency treatment of lower back post-herpetic neuralgia. Methods: One hundred and twenty-eight cases of lower back or anterior abdominal wall acute post-herpetic neuralgia patients were enrolled. They were randomly divided into two groups. Group A: oral treatment only with gabapentin+ celecoxib+ amitriptyline. Group B: while taking these drugs, patients were treated with radiofrequency pulses using a portable ultrasound device and the paravertebral puncture technique.In both groups, sudden outbreaks of pain were treated with immediate release 10 mg morphine tablets. Before and one week, two weeks, four weeks, eight weeks after treatment, visual analogue scale (VAS) was used for pain score, Pittsburgh sleep quality index scale (PSQI) was used to evaluate sleep quality, and morphine consumption was recorded. Eight weeks after treatment analgesic efficacy was evaluated. Treatment efficiency and significant efficiency was calculated while the occurrence of complications were documented. Results: In the control group, the VAS of T1,T2,T3 and T4 were 6.7 ±1.2, 5.2 ± 1.0, 3.3 ±1.1, 3.0±0.9.However, at the same time points, the VAS in the treatment group were 3.1±1.0, 2.2±0.7, 1.4±0.5, 1.2±0.5, respectively.The radio frequency group decreased significantly compared with the control group, the difference was statistically significant (t=17.925, 19.662, 12.580, 13.987, all P<0.05). Four weeks after treatment, the TNF-α in the control group was (11.04±2.36)ng/L, and the TNF-β in the radio frequency group was (8.07±2.13) ng/L. After the treatment, the TNF-α of the radio frequency group was lower than the control group, and the difference was statistically significant (t=-6.267, P<0.05). The IL-1β in the control group was (3.47±1.09) ng/L after treatment.The IL-1β in the radio frequency group was (1.96 ±0.56) ng/L, the IL-1β in the radio frequency group was lower than the control group and the difference was statistically significant (t=-8.266, P<0.05). Pearson correlation analysis showed that before and after the treatment of TNF-α were positively correlated with VAS score (r=0.455, 0.327, all P<0.05). IL-1β before and after treatment were positively correlated with VAS score (r=0.369, 0.357, all P<0.05). At T1,T2,T3 and T4, PSQI in the control group were 8.5±1.5, 7.3±1.4, 6.2±1.3 and 6.0±0.9 respectively.PSQI in the radio frequency group at the same time points were 6.5±1.4, 5.1±1.2, 4.0±1.1 and 3.9±0.5.Comparison between the two groups after treatment, radio frequency group was lower than the control group significantly, and the difference was statistically significant (t=7.798, 9.545, 10.335, 16.318, all P<0.05). Morphine consumption of the control group at T1,T2,T3,T4 were (22.5±2.2), (15.5±2.9), (6.8±1.5) and (4.2±0.9)mg.However, morphine consumption of the radio frequency group were (13.2±2.5), (7.2±2.7), (3.2±0.6) and (2.2±0.5)mg.Comparison between the two groups after treatment, morphine consumption of the radio frequency group decreased significantly than the control group, and the difference was statistically significant (t=22.341, 16.758, 17.827, 15.541, all P<0.05). During the operation , no error occurred with needle penetrating the abdominal cavity, chest, offal or blood vessels. Conclusion: Ultrasound-guided spinal nerve posterior ramus pulsed radio frequency treatment of lower back or anterior abdominal wall post-herpetic neuralgia proves effective and can reduce patient morphine usage and lead to fewer adverse reactions.目的： 评价超声引导脊神经后支脉冲射频治疗对老年下腰部带状疱疹性神经痛的疗效。 方法： 选取温州医科大学附属第一医院疼痛科2015年1月至2016年12月下腰或前腹壁急性带状疱疹性神经痛老年患者128例，性别不限，年龄65～75岁，带状疱疹病程1个月以内。随机数字表法分为两组(n＝64)，A组：单纯口服组(对照组)，口服加巴喷丁＋西乐葆组＋阿米替林。B组：脉冲射频组，在口服上述药物同时，采用便携超声仪，椎旁入路平面内技术穿刺，CT定位后行脉冲射频。两组出现爆发痛时均予以吗啡即释片10 mg口服。于治疗前(T0)、治疗1周后(T1)、2周后(T2)、4周后(T3)、8周后(T4)，采用视觉模拟评分量表(VAS)疼痛评分，匹兹堡睡眠质量指数量表(PSQI)进行睡眠质量评分，并观察吗啡用量。于治疗结束后8周进行镇痛疗效分级，计算治疗有效率和显效率，记录并发症的发生情况。并比较两组患者血清肿瘤坏死因子(TNF)-α、白细胞介素(IL)-1β的变化情况。 结果： 对照组T1、T2、T3、T4 VAS评分分别为(6.7±1.2)、(5.2±1.0)、(3.3±1.1)、(3.0±0.9)分，射频组分别为(3.1±1.0)、(2.2±0.7)、(1.4±0.5)、(1.2±0.5)分，组间同一时点比较，治疗后射频组较对照组明显降低，差异均有统计学意义(t＝17.925、19.662、12.580、13.987，均P<0.05)。对照组治疗4周后TNF-α为(11.04±2.36)ng/L，射频组为(8.07±2.13)ng/L，射频组较对照组低，差异有统计学意义(t＝－6.267，P<0.05)。对照组治疗4周后IL-1β为(3.47±1.09)ng/L，射频组为(1.96±0.56)ng/L，射频组较对照组低，差异有统计学意义(t＝－8.266，P<0.05)。Pearson相关性分析显示，治疗前后TNF-α与VAS评分呈正相关(r＝0.455、0.327，均P<0.05)；治疗前后IL-1β与VAS评分呈正相关(r＝0.369、0.357，均P<0.05)。对照组T1、T2、T3、T4时点睡眠质量评分分别为(8.5±1.5)、(7.3±1.4)、(6.2±1.3)、(6.0±0.9)分，射频组分别为(6.5±1.4)、(5.1±1.2)、(4.0±1.1)、(3.9±0.5)分，射频组较对照组明显降低，差异均有统计学意义(t＝7.798、9.545、10.335、16.318，均P<0.05)。对照组T1、T2、T3、T4时点吗啡消耗量分别为(22.5±2.2)、(15.5±2.9)、(6.8±1.5)、(4.2±0.9)mg，射频组分别为(13.2±2.5)、(7.2±2.7)、(3.2±0.6)、(2.2±0.5)mg，射频组较对照组明显降低，差异均有统计学意义(t＝22.341、16.758、17.827、15.541，均P<0.05)。操作过程中均无穿刺针误穿入腹腔、胸腔、内脏或血管等情况。 结论： 超声引导脊神经后支脉冲射频治疗对下腰或前腹壁带状疱疹性神经痛疗效确切，能减少患者吗啡应用，且患者不良反应少，其可能机制为降低患者炎症因子水平。.