| Objective: To prospectively investigate the clinical research,we can observe its clinical effects of radiofrequency hermocoagulation ablation combined with the heated herbal medicine compress method on lumbar zygapophysial joint pain.Meanwhile we could find a safe and more effective long-term pain-relieving effect way for the treatment of lumbar zygapophysial joint pain.Methods: In the first affiliated hospital of guangxi university of Chinese medicine,from October 2013 to March 2015,98 patients were determined as lumbar zygapophysial joint pain by medial branch block(MBB).They were randomly divided into three groups.35 cases underwent radiofrequency ablation therapy combined with the heated herbal medicine compress method(A group),while 33 cases underwent operation therapy(B group),while 30 cases underwent conservative therapy(C group).three groups met a criterion to the diagnosis standards of lumbar zygapophysial joint pain,excluding the patients with the lumbar disc herniation,spine fracture,lumbar spinal stenosis,digestive system diseases,the pregnancy,the breast-feeding period woman,psychosis,et a1.They also have the good compliance without falling off.A group: 22 males,13 females;the mean age was 65.05±8.38;the mean months of pain duration were 128.94±5.76;the patients' number of symptomatic segments at L2-3,L3-4 and L4-5 were 7,15 and 13,respectively.The mean VAS scores were 7.45±1.09.The mean JOA scores were 15.2±1.42.B group: 19 males,14females;the mean age was 68.12±9.08;the mean months of pain duration were 117.33±7.77;the patients' number of symptomatic segments at L2-3,L3-4 and L4-5 were 6,17 and 10,respectively.The mean VAS scores were 7.30±1.26.The mean JOA scores were 15.48±0.90.C group: 16 males,14 females;the mean age was 63.12±4.01;the mean months of pain duration were 49.33±2.07;the patients' number of symptomatic segments at L2-3,L3-4 and L4-5 were 4,14 and 12,respectively.The mean VAS scores were 6.40±1.13.The mean JOA scores were 17.83±1.53.There are comparability and no differences between the three groups(P>0.05).The three groups then received radiofrequency hermocoagulation ablation combined with ozone injection and,operation,conservative therapy respectively to observe the clinical effect of the treatment.Treatment: A group: the R-2000 B radiofrequency lesion generator was applied to treatment,which produced by Beijing Neoscience Limited Company.Operating electric current 0mA-2.0mA,lashing frequency 50 Hz to test sensory nerve.Turning electric current 0mA-2.0mA,lashing frequency 2Hz to test motor nerve.Motor stimulation was carried out to obtain a motor response of the multifidus muscle equal to or less than one volt of energy.Patients were monitored for leg pain and lower limb muscle contractions during the radiofrequency stimulation to verify absence of contractions.Once the proper needle placement was obtained with anterior–posterior,lateral,and oblique fluoroscopic guidance and after the administration of local anesthesia,a radiofrequency current was administered at each level at 65°-70° centigrade for 60 s.The ozone generator used in our study was produced by KastnerPraxisbedarf GmbH,Germany.3ml-10 ml of 25?g/mL ozone gas was injected into the puncture site.B group: 33 cases underwent operation therapy,including radiofrequency hermocoagulation ablation combined with ozone injected.C group : 30 cases underwent conservative treatment,including NSAIDs(Celecoxib capsules,Pfizer Pharmaceuticals Limited Company).The patient had been taking Celecoxib(200 mg daily)for 2 two weeks.We should record the adverse effects of NSAIDs.Effect evaluation standard: The VAS scores of lumbar zygapophysial joint pain were recorded at each time point.MacNab scores were evaluated at 1 years follow-up.The methods of statistics: with the SPSS17.0 statistics software,we adopted repeated measurements analysis of covariate to calculate the difference between each group before and after treatment.We use the chi-square test compare whether the differences between each groups of patients after treatment.P<0.05,the differences is significance.Results:1.VAS value compareIn A group,postoperative VAS scores of lumbar zygapophysial joint pain significantly decreased compared with those before treatment(P<0.05),which showed no significant difference with those after treatment(P>0.05).In B group,VAS scores of lumbar zygapophysial joint pain after treatment decreased significantly compared with that before treatment(P<0.05),which showed no significant difference with those after treatment 6 months(P>0.05).In C group,VAS scores of lumbar zygapophysial joint pain after treatment 3 months decreased significantly compared with that before treatment(P<0.05),which showed no significant difference with those after treatment 3 months(P>0.05).2.JOA value compareIn A group,postoperative JOA scores of lumbar zygapophysial joint pain significantly increased compared with those before treatment(P<0.05),which showed no significant difference with those after treatment(P>0.05).In B group,JOA scores of lumbar zygapophysial joint pain after treatment increased significantly compared with that before treatment(P<0.05),which showed no significant difference with those after treatment 6 months(P>0.05).In C group,JOA scores of lumbar zygapophysial joint pain after treatment 3 months increased significantly compared with that before treatment(P<0.05),which showed no significant difference with those after treatment 3 months(P>0.05).Conclusion(s):Radiofrequency thermocoagulation ablation combined with the the heated herbal medicine compress method is a safe and more effective long-term pain-relieving effect way for the treatment of lumbar zygapophysial joint pain.Results:2.VAS value compareIn A group,postoperative VAS scores of lumbar zygapophysial joint pain significantly decreased compared with those before treatment(P<0.05),which showed no significant difference with those after treatment(P>0.05).In B group,VAS scores of lumbar zygapophysial joint pain after treatment decreased significantly compared with that before treatment(P<0.05),which showed no significant difference with those after treatment 6 months(P>0.05).In C group,VAS scores of lumbar zygapophysial joint pain after treatment 3 months decreased significantly compared with that before treatment(P<0.05),which showed no significant difference with those after treatment 3 months(P>0.05).2.JOA value compareIn A group,postoperative JOA scores of lumbar zygapophysial joint pain significantly increased compared with those before treatment(P<0.05),which showed no significant difference with those after treatment(P>0.05).In B group,JOA scores of lumbar zygapophysial joint pain after treatment increased significantly compared with that before treatment(P<0.05),which showed no significant difference with those after treatment 6 months(P>0.05).In C group,JOA scores of lumbar zygapophysial joint pain after treatment 3 months increased significantly compared with that before treatment(P<0.05),which showed no significant difference with those after treatment 3 months(P>0.05).Conclusion(s):Radiofrequency thermocoagulation ablation combined with the the heated herbal medicine compress method is a safe and more effective long-term pain-relieving effect way for the treatment of lumbar zygapophysial joint pain. |
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