射频去神经术治疗慢性下腰痛的比较疗效：一项系统评价与网状Meta分析
Comparative efficacy of radiofrequency denervation in chronic low back pain: A systematic review and network meta-analysis.
作者信息
Li Han, An Junyan, Zhang Jun, Kong Weijian, Yun Zhihe, Yu Tong, Nie Xinyu, Liu Qinyi
机构信息
Department of Respiratory and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China.
Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China.
出版信息
Front Surg. 2022 Aug 5;9:899538. doi: 10.3389/fsurg.2022.899538. eCollection 2022.
BACKGROUND
Facet joint pain is a common cause of chronic low back pain (CLBP). Radiofrequency (RF) denervation is an effective treatment option.
PURPOSE
A systematic review and network meta-analysis (NMA) was performed to evaluate and compare the efficacy and effectiveness of different RF denervation treatments in managing facet joint-derived CLBP.
METHODS
The Cochrane Library, Embase, PubMed, and China Biology Medicine were searched to identify eligible randomized controlled trials (RCTs) from January 1966 through December 2021. Interventions included conventional radiofrequency denervation (CRF), pulsed radiofrequency denervation (PRF), pulsed radiofrequency treatment of the dorsal root ganglia (PRF-DRG), radiofrequency facet capsule denervation (RF-FC), and radiofrequency ablation under endoscopic guidance (ERFA). The outcome was the mean change in visual analog scale (VAS) score from baseline. A random-effects NMA was used to compare the pain relief effects of the interventions over the short term (≤6 months) and long term (12 months). The rank of effect estimation for each intervention was computed using the surface under the cumulative ranking curve.
RESULTS
A total of 10 RCTs with 715 patients met the inclusion criteria. Moderate evidence indicated that CRF denervation had a greater effect on pain relief than sham control in the short term (standardized mean difference (SMD) -1.58, 95% confidence intervals (CI) -2.98 to -0.18) and the long term (SMD -4.90, 95% CI, -5.86 to -3.94). Fair evidence indicated that PRF denervation was more effective than sham control for pain over the long term (SMD -1.30, 95% CI, -2.17 to -0.43). Fair evidence showed that ERFA denervation was more effective for pain relief than sham control in the short term (SMD -3.07, 95% CI, -5.81 to -0.32) and the long term (SMD -4.00, 95% CI, -4.95 to -3.05). Fair evidence showed that RF-FC denervation was more effective for pain relief than sham control in the long term (SMD -1.11, 95% CI, -2.07 to -0.15). A fair level of evidence indicated that PRF-DRG denervation was more effective for pain relief than sham control in the short term (SMD -5.34, 95% CI, -8.30 to -2.39).
CONCLUSION
RF is an effective option for patients diagnosed with facet joint-derived CLBP. Identifier: CRD42022298238.
背景
小关节疼痛是慢性下腰痛（CLBP）的常见原因。射频（RF）去神经支配是一种有效的治疗选择。
目的
进行系统评价和网状Meta分析（NMA），以评估和比较不同RF去神经支配治疗在管理小关节源性CLBP中的疗效和有效性。
方法
检索Cochrane图书馆、Embase、PubMed和中国生物医学数据库，以识别1966年1月至2021年12月符合条件的随机对照试验（RCT）。干预措施包括传统射频去神经支配（CRF）、脉冲射频去神经支配（PRF）、背根神经节脉冲射频治疗（PRF-DRG）、射频小关节囊去神经支配（RF-FC）和内镜引导下射频消融（ERFA）。结局指标是视觉模拟量表（VAS）评分相对于基线的平均变化。采用随机效应NMA比较干预措施在短期（≤6个月）和长期（12个月）的疼痛缓解效果。使用累积排序曲线下的面积计算每种干预措施的效应估计排名。
结果
共有10项RCT（715例患者）符合纳入标准。中等证据表明，CRF去神经支配在短期（标准化均数差（SMD）-1.58，95%置信区间（CI）-2.98至-0.18）和长期（SMD -4.90，95%CI，-5.86至-3.94）对疼痛缓解的效果优于假对照。中等证据表明，PRF去神经支配在长期对疼痛的缓解比假对照更有效（SMD -1.30，95%CI，-2.17至-0.43）。中等证据表明，ERFA去神经支配在短期（SMD -3.07，95%CI，-5.81至-0.32）和长期（SMD -4.00，95%CI，-4.95至-3.05）对疼痛缓解比假对照更有效。中等证据表明，RF-FC去神经支配在长期对疼痛缓解比假对照更有效（SMD -1.11，95%CI，-
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