内窥镜下脊神经背内侧支切断术治疗腰椎关节突关节源性慢性腰痛

Endoscopic dorsal rhizotomy for chronic lumbar zygapophyseal joint originated pain

中文关键词:  慢性腰痛  脊神经背内侧支切断术  内窥镜  关节突关节源性疼痛  小关节综合征

英文关键词:Chronic low back pain  Medial branch neurotomy  Endoscopic  Rhizotomy  Lumbar zygapophyseal joint originated pain  Facet syndrome

中文摘要:

  【摘要】 目的：探讨内窥镜下脊神经背内侧支切断术治疗腰椎关节突关节源性慢性腰痛的效果。方法：2011年4月~2011年10月，收治58例分别使用利多卡因和布比卡因行对照性脊神经背内侧支封闭术证实疼痛80%以上来源于腰椎关节突关节的慢性腰痛患者，其中45例接受内窥镜下脊神经背内侧支切断术治疗（手术治疗组），其余13例接受药物、理疗及认知治疗等保守治疗（保守治疗组）。封闭前、封闭后、治疗后1d、3个月、6个月及12个月时记录患者腰痛及牵涉痛的VAS评分，术后12个月时行腰椎MacNab功能评分评估两组的疗效，比较两种治疗方法腰痛缓解率的差异。结果：手术治疗组术后1d、3个月、6个月及12个月时腰痛及牵涉痛VAS评分较封闭前均明显降低（P<0.05），术后各时间点比较无显著性差异（P>0.05），无手术并发症发生；保守治疗组封闭后腰痛及牵涉痛VAS评分较封闭前明显降低（P<0.05），保守治疗组治疗后腰痛及牵涉痛VAS评分较封闭前明显降低（P<0.05），但均明显高于封闭后VAS评分（P<0.05）。手术治疗组术后各时间点腰痛及牵涉痛疼痛缓解率均明显高于保守治疗组（P<0.01）。术后1年随访MacNab功能评分：手术治疗组优27例，良17例，可1例；保守治疗组可6例，差7例。结论：内窥镜下脊神经背内侧支切断术是治疗腰椎关节突关节源性慢性腰痛安全、有效的方法，疗效优于传统保守治疗方法。

英文摘要:

  【Abstract】 Objectives: To prospectively investigate the clinical outcome of endoscopic dorsal rhizotomy(endoscopic lumbar medial branch neurotomy) for chronic lumbar zygapophyseal joint originated pain. Methods: From April 2011 to October 2011, 58 patients with chronic low back pain were determined as chronic lumbar zygapophyseal joint originated pain by more than 80% pain relief after controlled differential(double) medial branch block(MBB) with lidocaine and bupivacaine respectively. 45 cases underwent endoscopic dorsal rhizotomy(operation group), while 13 cases underwent conservative treatment, including NSAIDs, physical therapy and recognition therapy(conservative group). The VAS scores of low back pain and referred pain were recorded at each time point, including VAS scores before MBB, after MBB, 1d, 3 months, 6 months and 12 months postoperatively. MacNab scores were evaluated at 12 month follow-up. The clinical outcomes of endoscopic dorsal rhizotomy and conservative treatment were analyzed and compared. Results: In operation group, postoperative VAS scores of low back pain and referred pain significantly decreased compared with those before MBB(P<0.05), which showed no significant difference with those after MBB(P>0.05). In conservative group, VAS scores of low back pain and referred pain after treatment decreased significantly compared with that before MBB(P<0.05) and were significantly higher than those after MBB(P<0.05). The rate of pain relief in operation group was significantly higher than that in conservative group(P<0.01). MacNab scores of 1 year follow-up included 27 excellent, 17 good, 1 fair in operation group and 6 fair, 7 poor in conservative group respectively. Conclusions: Endoscopic dorsal rhizotomy is safe and effective for chronic lumbar zygapophyseal joint originated pain, which is superior over conservative treatment.