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顽固性腰骶部神经根性疼痛患者脉冲射频治疗成功结局的预测因素

Predictive Factors for Successful Outcome of Pulsed Radiofrequency Treatment in Patients with Intractable Lumbosacral Radicular Pain.

作者信息

Van Boxem Koen, de Meij Nelleke, Patijn Jacob, Wilmink Jan, van Kleef Maarten, Van Zundert Jan, Kessels Alfons

机构信息

Departments of *Anesthesiology and Pain Management, Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Sint-Jozefkliniek, Bornem & Willebroek, Belgium;

Departments of *Anesthesiology and Pain Management,

出版信息

Pain Med. 2016 Jul;17(7):1233-1240. doi: 10.1093/pm/pnv052. Epub 2016 Jan 20.

Abstract

BACKGROUND

In a previous prospective study on pulsed radiofrequency (PRF) treatment adjacent to the lumbar dorsal root ganglion (DRG) for patients with chronic lumbosacral radicular pain, we reported success in 55.4% of the patients at 6 months. Identification of predictors for success after PRF may improve outcome. We assessed the predictors of PRF in patients with chronic intractable lumbosacral radicular pain.

METHODS

Patients with monosegmental chronic lumbosacral radicular pain of L5 or S1 first received a selective nerve root block at the corresponding level. Independent of the result of this block a PRF treatment at the same level was performed. At 6 weeks, 3 months, and 6 months after the procedure the outcome was evaluated.

RESULTS

A positive diagnostic nerve root block and age ≥ 55 were predictive factors for successful outcome at 6 months, while disability was a negative predictor.The use of failed back surgery syndrome, gender, duration of pain, Numerical Rating Scale, level and side of treatment, DN4, and RAND-36 as predictors for success was not supported.

CONCLUSIONS

Successful outcome after PRF adjacent to the DRG, in patients with intractable chronic lumbosacral radicular pain, is more likely in patients ≥ 55 years, with limited disability and after a positive diagnostic nerve root block. A combination of all these factors creates a fair predictive value (AUC: 0.73).

摘要

背景

在先前一项针对慢性腰骶部神经根性疼痛患者,在腰背部脊神经节(DRG)附近进行脉冲射频(PRF)治疗的前瞻性研究中,我们报告6个月时55.4%的患者治疗成功。确定PRF治疗成功的预测因素可能会改善治疗效果。我们评估了慢性顽固性腰骶部神经根性疼痛患者PRF治疗的预测因素。

方法

患有L5或S1单节段慢性腰骶部神经根性疼痛的患者首先在相应节段接受选择性神经根阻滞。无论该阻滞结果如何,均在同一节段进行PRF治疗。在治疗后6周、3个月和6个月评估治疗效果。

结果

诊断性神经根阻滞结果为阳性以及年龄≥55岁是6个月时治疗成功的预测因素,而功能障碍是负面预测因素。使用失败的脊柱手术综合征、性别、疼痛持续时间、数字评分量表、治疗节段和侧别、DN4以及RAND-36作为成功的预测因素未得到证实。

结论

对于顽固性慢性腰骶部神经根性疼痛患者,在DRG附近进行PRF治疗后,年龄≥55岁、功能障碍有限且诊断性神经根阻滞结果为阳性的患者更有可能获得成功治疗效果。所有这些因素的组合具有较好的预测价值(曲线下面积:0.73)。

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