中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (28): 4491-4496.doi: 10.3969/j.issn.2095-4344.1455

• 脊柱植入物 spinal implant • 上一篇    下一篇

脉冲射频联合补钙治疗骨质疏松性椎体压缩骨折所致胸背痛

聂会勇1，张丹丹2，卜  岗1，王锁良1，吕  军3
  

  1. 西安交通大学第一附属医院，1疼痛科，2老年内一科，3临床研究中心，陕西省西安市    710061
  • 出版日期:2019-10-08 发布日期:2019-10-08
  • 通讯作者: 吕军，博士，副主任医师，西安交通大学第一附属医院临床研究中心，陕西省西安市 710061
  • 作者简介:聂会勇，男，1981年生，河南省伊川县人，汉族，2008年西安交通大学毕业，硕士，主治医师，主要从事慢性疼痛疾病的诊断和治疗。
  • 基金资助:
    国家社会科学基金一般项目(16BGL183)，项目负责人：吕军

Pulse radiofrequency combined with regular calcium supplement in the treatment of thoracic and back pain caused by osteoporotic vertebral compression fractures

Nie Huiyong1, Zhang Dandan2, Bu Gang1, Wang Suoliang1, Lü Jun3 
  

  1. 1Department of Pain Management, 2First Department of Geriatrics, 3Clinical Research Center, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
  • Online:2019-10-08 Published:2019-10-08
  • Contact: Lü Jun, MD, Associate chief physician, Clinical Research Center, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
  • About author:Nie Huiyong, Master, Attending physician, Department of Pain Management, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
  • Supported by:
    the General Project of the National Social Science Fund, No. 16BGL183 (LJ)

PDF

208

摘要：

文章快速阅读：


文题释义：
脉冲射频：即在42 ℃的工作环境中，通过射频针周围的射频电流来阻断神经的疼痛信号传导。传统的观点认为射频电流是通过热效应致神经阻滞损伤而达到神经阻滞的治疗作用，而后来的研究证实阻滞神经的是射频电流而不是热效应。研究结果表明，42 ℃的脉冲射频电流可以起到与射频电流67 ℃同样的治疗效果。而在42 ℃的环境里，人体的组织损伤的概率明显下降，在保证治疗有效性的同时进一步降低并发症的发生。
骨质疏松性椎体压缩骨折所致腰背痛：临床过程中发现大量的老年患者出现不明原因的胸背痛，尤其是左侧胸背痛往往被当作心脏病进行检查和治疗，而经过胸椎的X射线检查后才知道是由于骨质疏松引起胸椎楔形变，也就是椎体压缩性骨折。该骨折可导致患者出现相应脊神经支配区域的疼痛，在临床诊断和治疗上专科性较强，一般的理疗、口服消炎止痛药物治疗效果不佳，往往需要综合的评估和专业的治疗才能获得满意的治疗效果。
 
摘要
背景：骨质疏松性椎体压缩骨折所致的胸背部疼痛在临床上很常见，而作为常规的治疗方法如口服消炎止痛药物、理疗、补钙和局部神经阻滞有一定的治疗效果，但往往停药不久疼痛又重复出现。而脉冲射频治疗骨质疏松性椎体压缩骨折所致的胸背部疼痛短期疗效显著，但是多数报道缺乏规范的骨质疏松治疗，远期效果欠佳。
目的：探讨脉冲射频联合指南补钙治疗骨质疏松性椎体压缩骨折引起的胸椎脊神经根性疼痛的效果。
方法：将收治的110例骨质疏松性椎体压缩骨折患者随机分为2组，每组55例。2组患者对治疗方案均知情同意，且得到医院伦理委员会批准。脉冲射频组对椎体压缩性骨折对应脊神经背根节行脉冲射频治疗；神经阻滞组对相应脊神经背根节行神经阻滞治疗；2组均应用碳酸钙D3、降钙素和唑来膦酸治疗骨质疏松症。随访治疗前和治疗后1，3，6，12个月，比较2组患者反映疗效的目测类比评分和Oswestry功能障碍指数；比较2组反映骨质疏松改善程度的人Ⅰ型原胶原N端前肽和抗酒石酸酸性磷酸酶异构体5 b水平。
结果与结论：①2组治疗后1，3，6，12个月的目测类比评分和Oswestry功能障碍指数较治疗前显著改善(P < 0.05)；组间比较，在治疗后1个月，2组差异无显著性意义(P > 0.05)，而治疗后3，6，12个月，脉冲射频组目测类比评分和Oswestry功能障碍指数改善情况优于神经阻滞组(P < 0.05)；②人Ⅰ型原胶原N端前肽和抗酒石酸酸性磷酸酶异构体5b水平在治疗后1个月和治疗前比较，脉冲射频组、神经阻滞组差异均无显著性意义(P > 0.05)；在治疗后3，6，12个月时2组人Ⅰ型原胶原N端前肽和抗酒石酸酸性磷酸酶异构体5b水平均较治疗前显著改善(P < 0.05)；③提示脉冲射频联合指南补钙治疗骨质疏松性椎体压缩骨折所致胸背痛可明显改善患者疼痛程度和生活质量；从根本上改善骨质疏松症，远期效果满意。

ORCID:0000-0003-0922-7319(聂会勇)

关键词: 脉冲射频, 骨质疏松症, 椎体压缩性骨折, 局部神经阻滞, 脊神经根性疼痛

Abstract:

BACKGROUND: Thoracic and dorsal pain caused by osteoporotic vertebral compression fractures is very common in clinic. Conventional treatment methods include medicine, physiotherapy, calcium supplement and local nerve block. They all have certain therapeutic effects, but the pain recurs shortly after drug withdrawal. As a technique for treating this kind of pain, pulsed radio frequency has a remarkable short-term effect, but it lacks standardized treatment for osteoporosis, and its long-term effect is not good.
OBJECTIVE: To investigate the therapeutic effect of pulsed radio frequency combined with guideline calcium supplement on thoracic spinal nerve root pain caused by osteoporotic vertebral compression fracture.
METHODS: The 110 patients with osteoporotic vertebral compression fractures were randomly divided into two groups, with 55 cases in each group. Informed consent was obtained from patients of the two groups. This study was approved by the Hospital Ethics Committee. Pulsed radiofrequency group received pulsed radiofrequency treatment for vertebral compression fracture corresponding to dorsal root ganglion of spinal nerve. Nerve block group received nerve block treatment for corresponding dorsal root ganglion of spinal nerve. Both groups were treated with calcium carbonate D3, calcitonin and zoledronic acid for osteoporosis. Visual Analogue Scale and Oswestry Dysfunction Index results were compared between the two groups before and 1, 3, 6 and 12 months after treatment. The N-terminal propeptide of human procollagen type I and tartrate-resistant acid phosphatase isomer 5b levels were compared between the two groups.
RESULTS AND CONCLUSION: (1) The Visual Analogue Scale score and Oswestry Dysfunction Index were significantly improved in both groups after 1, 3, 6 and 12 months of treatment compared with those before treatment (P < 0.05). In 1 month after operation, there was no significant difference between the two groups (P > 0.05). In 3, 6 and 12 months after operation, the improvement of Visual Analogue Scale score and Oswestry Dysfunction Index in the pulsed radiofrequency group was better than that in the nerve block group (P < 0.05). (2) There was no significant difference in bone metabolism indexes N-terminal propeptide of human procollagen type I and tartrate-resistant acid phosphatase isomer 5b between the two groups at 1 month after operation and before operation (P > 0.05). N-terminal propeptide of human procollagen type I and tartrate-resistant acid phosphatase isomer 5b in the two groups were significantly improved at 3, 6 and 12 months after operation (P < 0.05). (3) Pulse radio frequency combined with guideline calcium supplement in the treatment of chest and back pain caused by osteoporotic vertebral compression fractures can not only noticeably reduce pain and improve the quality of life, but also fundamentally improve osteoporosis, with satisfactory short-term and long-term results.

Key words: pulse radiofrequency, osteoporosis, osteoporotic vertebral compression fracture, local nerve block, radicular pain

中图分类号: