一项随机对照试验，比较多叉套管与传统套管用于慢性颈部疼痛的颈椎内侧支射频神经切断术的技术特点和临床疗效。

Randomized controlled trial comparing technical features and clinical efficacy of a multi-tined cannula versus a conventional cannula for cervical medial branch radiofrequency neurotomy in chronic neck pain.

作者信息

Filiatrault Kim, Mares Christopher, Filiatrault Marc, Levasseur Marie-Ève, Chang Min Cheol, Denis Isabelle

机构信息

Department of Physical Medicine and Rehabilitation, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 rue Sanguinet, Montréal, Québec (Qc), H2X 3E4, Canada.

Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Daegu, Republic of Korea.

出版信息

Interv Pain Med. 2023 Aug 4;2(3):100272. doi: 10.1016/j.inpm.2023.100272. eCollection 2023 Sep.

OBJECTIVES

Compare procedural characteristics and clinical efficacy of cervical medial branch radiofrequency neurotomy (CMBRFN) using a multi-tined cannula (MTC) versus a conventional cannula (CC) to treat chronic neck pain.

DESIGN

Prospective, double-blinded randomized controlled trial.

METHODS

Patients who responded to dual medial branch blocks with ≥75% pain relief were randomized to receive RFN with either the MTC or the CC. Primary outcomes: procedural pain, procedure duration, fluoroscopy time and radiation dose. Secondary outcomes: proportion of patients reporting ≥50% numerical rating scale reduction and ≥30% neck disability index reduction at 3, 6 and 12 months.

RESULTS

Forty-two patients underwent treatment. There was no difference in procedural pain between the MTC and CC groups (NRS 4.7 ± 2.0 vs. 4.2 ± 1.8, p = 0.465), but three patients, all in the CC group, could not complete the procedure due to pain. CMBRFN in the MTC group was significantly faster than in the CC group (35.5 ± 7.3 min vs. 58.2 ± 14.8 min, p < 0.001), with less fluoroscopy time (167.6 ± 76.4 s vs. 260.8 ± 123.5 s, p = 0.004). Radiation dose was 8.95 ± 7.9 mGy in the MTC group and 11.53 ± 10.3 mGy in the CC group (p = 0.36). Rates of ≥50% NRS reduction were not significantly different between the two groups at 3 months, but at 6 and 12 months, they were significantly higher in the CC group. At 3, 6 and 12 months, rates of ≥30% NDI reduction were significantly higher in the CC group.

CONCLUSIONS

The MTC offers technical advantages compared to the CC for both the operator and the patient. However, CMBRFN with the multi-tined cannula seems less effective to treat neck pain than with the conventional cannula.

目的

比较使用多尖套管（MTC）与传统套管（CC）进行颈椎内侧支射频神经切断术（CMBRFN）治疗慢性颈部疼痛的手术特点和临床疗效。

设计

前瞻性、双盲随机对照试验。

方法

对双侧内侧支阻滞疼痛缓解≥75%的患者随机分组，分别接受使用MTC或CC的射频神经切断术。主要结局：手术疼痛、手术时长、透视时间和辐射剂量。次要结局：在3、6和12个月时，报告数字评定量表降低≥50%和颈部功能障碍指数降低≥30%的患者比例。

结果

42例患者接受治疗。MTC组和CC组的手术疼痛无差异（数字评定量表分别为4.7±2.0和4.2±1.8，p = 0.465），但CC组有3例患者因疼痛无法完成手术。MTC组的CMBRFN明显比CC组快（35.5±7.3分钟 vs. 58.2±14.8分钟，p < 0.001），透视时间更短（167.6±76.4秒 vs. 260.8±123.5秒，p = 0.004）。MTC组的辐射剂量为8.95±7.9 mGy，CC组为11.53±10.3 mGy（p = 0.36）。两组在3个月时数字评定量表降低≥50% 的比例无显著差异，但在6个月和12个月时，CC组显著更高。在3、6和12个月时，CC组颈部功能障碍指数降低≥30% 的比例显著更高。