The Clinical Effect of Ultrasound-guided Intercostal Nerve Pulsed Radiofrequency on the Treatment of Postherpetic Neuralgia at the Upper Thoracic Segment
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摘要:
目的 观察超声引导肋间神经脉冲射频射频治疗胸椎高节段带疱疹后神经痛的临床疗效。 方法 选择第1、2、3肋间神经支配区域的胸背部带状疱疹后神经痛患者67例，根据治疗方式不同随机分为试验组与对照组，试验组34例，男15例，女19例，平均年龄为（50.6±11.5）岁，在超声引导下行第1、2、3肋间神经脉冲射频治疗；对照组33例，男16例，女17例，平均年龄为（51.5±12.7）岁，在超声引导下行第1、2、3肋间神经阻滞。比较治疗前、治疗后1、3、6、12个月的VAS疼痛评分、Pain DETECT量表评分变化，以及观察治疗后1a内症状复发率。 结果 67例患者治疗后获完全随访。治疗后2组患者均无不良反应发生。试验组患者治疗后1、3、6、12个月VAS疼痛评分、Pain DETECT量表评分显著优于对照组患者，差异有统计学意义（P < 0.05）；同一组内患者治疗后1、3、6、12个月VAS疼痛评分、Pain DETECT量表评分较治疗前显著改善，差异有统计学意义（P < 0.05），试验组治疗后1 a内症状复发率明显低于对照组治疗后1 a内症状复发率，差异有统计学意义（P < 0.05）。 结论 超声引导下肋间神经脉冲射频射频可治疗高节段胸神经区域带状疱疹后神经痛，疗效显著，安全性高，值得推广。 Abstract:Objective To evaluate the clinical effect of ultrasound-guided intercostal nerve pulsed radiofrequency on the treatment of postherpetic neuralgia in the upper thoracic segment after herpes zoster infection. Methods A total of 67 patients with postherpetic neuralgia in the intercostal nerve of the thoracic region （segments 1, 2, and 3） and back region were included in this study. The patients were randomly assigned into an experimental group and a control group based on the type of treatment method. The experimental group consisted of 34 participants, including 15 males and 19 females, with an average age of （50.6±11.5） years. Pulsed radiofrequency procedure was performed on the intercostal nerves of segments 1, 2, and 3 under the ultrasound guidance for the subjects in the experimental group. The control group comprised 33 subjects, including 16 males and 17 females, with an average age of （51.5±12.7） years. Intercostal nerve block procedure was performed on segments 1, 2, and 3 under the ultrasound guidance for the patients in the control group. The visual analog scale （VAS） pain scores and Pain DETECT scale scores were compared before the treatment and at 1, 3, 6, and 12 months after the treatment for the two groups. The recurrence rate of symptoms within 1 year after the treatment was determined and compared between the two groups. Results Complete follow-up was achieved in the 67 patients after the treatment, and the study subjects did not present with adverse reactions. The VAS pain scores and Pain DETECT scale scores at 1, 3, 6, and 12 months after the treatment were significantly better in the experimental group than in the control group （P < 0.05）. The VAS pain scores and Pain DETECT scale scores at 1, 3, 6, and 12 months after the treatment were significantly improved compared with the pre-treatment scores for the two groups （P < 0.05）. The recurrence rate of symptoms within 1 year after the treatment was significantly lower in the experimental group than in the control group （P < 0.05）. These results showed that pulsed radiofrequency method was more effective for the treatment of postherpetic neuralgia in the upper thoracic segment after herpes zoster infection and had less adverse effects compared with the intercostal nerve block approach. Conclusion Ultrasound-guided intercostal nerve pulsed radiofrequency treatment is effective and safe for the treatment of postherpetic neuralgia in the upper thoracic segment after herpes zoster. -
表 1 2组患者一般资料的比较（n/$ \bar x \pm s $）
Table 1. Compared between two groups before operation（n/$ \bar x \pm s $）
组别 性别 年龄
（岁）患侧 BMI
（kg/m2）合并症 发病至治疗时间
（月）男 女 左 右 有 无 试验组（n ＝ 34）
对照组（n ＝ 33）15 19 50.6±11.5 18 16 24.7±3.9 21 15 4.5±2.5 16 17 51.5±9.2 17 16 23.9±2.7 19 14 4.0±2.2 χ2 χ2=0.128 t=−0.323 χ2=0.014 t=0.837 χ2=0.122 t=0.977 0.720 0.747 0.907 0.406 0.727 0.332 
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表 2 2组患者治疗前及治疗后1、3、6、9个月VAS评分的比较（$ \bar x \pm s $，分）
Table 2. Comparison of VAS scores between two groups of patients before and after treatment（$ \bar x \pm s $，scores）
组别 治疗前 治疗后 F P 1月 3月 6月 12月 试验组（n=34） 7.35±0.69 2.11±0.54* 1.94±0.49* 1.88±0.32* 1.82±0.39* 790.648 <0.001 对照组（n=33） 7.06±0.74 4.52±1.20* 4.18±0.129* 3.88±1.05* 3.96±1.07* 49.318 <0.001 t 1.663 −10.592 −9.481 −9.982 −10.246 P 0.101 0.000 0.000 0.000 0.000 VAS为视觉评分法；治疗后各月与治疗前比较，*P < 0.05。
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表 3 2组患者治疗前及治疗后1、3、6、9个月Pain DETECT评分的比较（$ \bar x \pm s $，分）
Table 3. Comparison of Pain DETECT scores between two groups of patients before and after treatment（$ \bar x \pm s $，scores）
组别 治疗前 治疗后 F P 1月 3月 6月 12月 试验组（n=34） 19.85±1.74 10.88±0.84* 10.74±0.90* 10.59±0.96* 10.38±0.98* 729.123 <0.001 对照组（n=33） 19.52±1.83 14.76±1.91* 14.39±1.89* 14.03±1.93* 13.91±1.86* 60.431 <0.001 t 4.751 −10.821 −10.184 −9.294 −9.477 P 0.085 0.000 0.000 0.000 0.000 与治疗前比较，*P < 0.05。
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表 4 2组患者治疗后复发率的比较[n（%）]
Table 4. Comparison of recurrence rates between two groups of patients after treatment[n（%）]
组别 复发率 试验组（n=34） 9（25.00） 对照组（n=33） 17（51.52） χ2 5.155 P 0.023
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