McDonald G J, Lord S M, Bogduk N
Newcastle Bone and Joint Institute, University of Newcastle, NSW, Australia.
Neurosurgery. 1999 Jul;45(1):61-7; discussion 67-8. doi: 10.1097/00006123-199907000-00015.
To determine the long-term efficacy of percutaneous radiofrequency medial branch neurotomy in the treatment of chronic neck pain.
Between 1991 and 1996, radiofrequency neurotomy was performed in 28 patients diagnosed as having cervical zygapophysial joint pain on the basis of controlled diagnostic blocks. The procedure was repeated in patients whose pain recurred. Outcome measures were the proportion of patients who responded to the initial procedure and the duration of relief subsequently obtained. Outcome was correlated with the operator performing the procedure, the type of electrode used, litigation status, and the type of diagnostic blocks used to establish the diagnosis.
Complete relief of pain was obtained in 71% of patients after an initial procedure. No patient who failed to respond to a first procedure responded to a repeat procedure, but if pain returned after a successful initial procedure, relief could be reinstated by a repeat procedure. The median duration of relief after a first procedure was 219 days when failures are included but 422 days when only successful cases are considered. The median duration of relief after repeat procedures was at least 219 days; several patients had ongoing relief at the time of follow-up. Outcome did not differ according to the operator, the type of electrode used, litigation status, or the type of diagnostic block used.
Radiofrequency neurotomy provides clinically significant and satisfying periods of freedom from pain, and its effects can be reinstated if pain recurs.
确定经皮射频内侧支神经切断术治疗慢性颈部疼痛的长期疗效。
1991年至1996年间，对28例经对照诊断性阻滞确诊为颈椎关节突关节疼痛的患者实施了射频神经切断术。疼痛复发的患者重复该手术。观察指标为对初次手术有反应的患者比例以及随后获得的缓解持续时间。结果与实施手术的操作人员、使用的电极类型、诉讼状态以及用于确立诊断的诊断性阻滞类型相关。
初次手术后71%的患者疼痛完全缓解。初次手术无反应的患者再次手术均无反应，但初次手术成功后疼痛复发的患者，再次手术可恢复疼痛缓解。将失败病例纳入计算时，初次手术后缓解的中位持续时间为219天，仅考虑成功病例时为422天。再次手术后缓解的中位持续时间至少为219天；数名患者在随访时疼痛持续缓解。结果在操作人员、使用的电极类型、诉讼状态或用于诊断的诊断性阻滞类型方面无差异。
射频神经切断术可提供临床上显著且令人满意的无痛期，疼痛复发时其效果可恢复。
