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[CT引导下特定下腰痛的疼痛管理：椎间盘损伤与骨质退变]

[CT-guided pain management of specific low back pain : Disc impairment vs. osseous degeneration].

作者信息

Stueckle Christoph A, Talarczyk Sarah, Stueckle Kerstin F, Haage Patrick

机构信息

Fakultät für Gesundheit, Universität Witten/Herdecke, Witten, Deutschland.

Zentrum für Radiologie, Helios Universitätsklinikum Wuppertal, Wuppertal, Deutschland.

出版信息

Radiologe. 2021 Aug;61(8):758-766. doi: 10.1007/s00117-021-00850-2. Epub 2021 May 12.

DOI:10.1007/s00117-021-00850-2
PMID:33978768
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8328855/
Abstract

BACKGROUND

Back pain is common and leads the patient to the radiologist both for diagnosis and in specific cases for therapy.

OBJECTIVES

The current study compares the pain-reducing effect of microinvasive computed tomography (CT)-guided pain therapy for specific back pain caused by herniated discs or spondylarthrosis.

MATERIALS AND METHODS

Over a period of 3.3 years, a total of 239 patients were included, in whom 686 CT-guided periradicular therapies (PRT) and 264 CT-guided facet joint therapies (FAC) were performed. In all patients, the pain score was determined using a visual analog pain scale (VAS) before the intervention, during the course of treatment and at the end of treatment. Finally, treatment success was correlated to the type of treatment performed and to the morphological changes present.

RESULTS

Both groups showed good improvement of pain under treatment (74% of the PRT patients and 60% of the FAC patients). Patients who underwent PRT showed an average improvement in pain score of 3.1, while those who underwent FAC showed an average improvement of 2.1. The efficacy of FAC was dependent on the degree of degenerative changes present. The more extensive the proven degeneration was in the treated segment, the more interventions were necessary for a good treatment response.

CONCLUSION

CT-guided PRT and CT-guided FAC both lead to a good reduction of pain symptoms. In comparison, PRT achieves significantly higher pain reduction than FAC.

摘要

背景

背痛很常见，患者会因诊断以及在特定情况下因治疗而前往放射科医生处就诊。

目的

本研究比较了微创计算机断层扫描（CT）引导下的疼痛治疗对椎间盘突出或脊椎关节病引起的特定背痛的止痛效果。

材料与方法

在3.3年的时间里，共纳入239例患者，对其进行了686次CT引导下的神经根周围治疗（PRT）和264次CT引导下的小关节治疗（FAC）。在所有患者中，在干预前、治疗过程中和治疗结束时使用视觉模拟疼痛量表（VAS）确定疼痛评分。最后，将治疗成功与否与所进行的治疗类型以及存在的形态学变化相关联。

结果

两组患者在治疗过程中疼痛均有明显改善（PRT组74%的患者，FAC组60%的患者）。接受PRT治疗的患者疼痛评分平均改善3.1，而接受FAC治疗的患者平均改善2.1。FAC的疗效取决于存在的退变程度。在治疗节段中证实的退变越广泛，为获得良好的治疗反应所需的干预就越多。

结论

CT引导下的PRT和CT引导下的FAC均能显著减轻疼痛症状。相比之下，PRT的止痛效果明显高于FAC。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/addc/8328855/0e3cb82e2613/117_2021_850_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/addc/8328855/7157974e9ff7/117_2021_850_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/addc/8328855/ab2ed290e167/117_2021_850_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/addc/8328855/568f7662e2a8/117_2021_850_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/addc/8328855/32a607ca5c5b/117_2021_850_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/addc/8328855/0e3cb82e2613/117_2021_850_Fig5_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/addc/8328855/7157974e9ff7/117_2021_850_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/addc/8328855/ab2ed290e167/117_2021_850_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/addc/8328855/568f7662e2a8/117_2021_850_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/addc/8328855/32a607ca5c5b/117_2021_850_Fig4_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/addc/8328855/0e3cb82e2613/117_2021_850_Fig5_HTML.jpg

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本文引用的文献

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CT-guided Interventional Therapy of Back Pain - Predictors of Success in Treatment.CT 引导下的腰痛介入治疗 - 治疗成功的预测因素。
Rofo. 2021 Jan;193(1):42-48. doi: 10.1055/a-1161-9358. Epub 2020 Jul 16.
2
Outcome of intra-articular lumbar facet joint corticosteroid injection according to the severity of facet joint arthritis.根据小关节关节炎的严重程度，关节内腰椎小关节皮质类固醇注射的结果
Exp Ther Med. 2019 Nov;18(5):4132-4136. doi: 10.3892/etm.2019.8031. Epub 2019 Sep 20.
3
Cervical radiculopathy: open study on percutaneous periradicular foraminal steroid infiltration performed under CT control in 30 patients.神经根型颈椎病：30例患者在CT引导下经皮神经根周围椎间孔类固醇注射的开放性研究。
AJNR Am J Neuroradiol. 2004 Mar;25(3):441-5.