背景:胸神经根的射频热凝(RFT)通常用于治疗药物难治性胸疱疹后神经痛(PHN)。然而,RFT程序欠佳的疼痛缓解和术后皮肤麻木的高发生率带来了持续的挑战。先前的单队列研究表明,低温等离子消融术可能会改善疼痛缓解并降低皮肤麻木的发生率。然而,缺乏支持虚张声势而不是RFT的确凿证据。
目的:比较消融术与RFT治疗难治性PHN的临床结果。
方法:回顾性配对队列研究。
方法:首都医科大学附属医院.
方法:在2019年至2020年期间,68例PHN患者接受了消融术,在2015年至2020年期间,312例患者接受了RFT。根据年龄标准进行了配对队列分析,性别,体重,疼痛强度,疼痛持续时间,疼痛的一面,和受影响的胸部皮段。使用数字评定量表(NRS)评估疼痛缓解情况,药物定量量表(MQS)第三版和神经性疼痛症状量表(NPSI),用来指示疼痛强度,药物负担,在6、12和24个月时全面缓解疼痛。记录麻木程度量表评分和并发症,以评估安全性。
结果:我们成功匹配了59例接受消融术的患者和同等数量的接受RFT作为PHN治疗的患者。在后续时间点,两组NRS,MQS,NPSI评分较术前显著降低(P<0.05)。在第6个月和第24个月,消融组的NRS评分明显低于RFT组(P<0.05)。24个月时,消融组的MQS值明显低于RFT组(P<0.05)。此外,在12个月和24个月的随访中,消融组的NPSI总强度评分明显低于RFT组(P<0.05)。6个月时,消融组的NPSI临时强度评分明显低于RFT组(P<0.05)。值得注意的是,在6个月和12个月时,消融术组的中度或重度麻木发生率明显低于RFT组(P<0.05)。随访期间未报告严重不良反应。
结论:本分析是单中心回顾性研究,样本量较小。
结论:在此匹配的队列分析中,与RFT相比,消融术可实现更长期的疼痛缓解,皮肤麻木的发生率更低。应进行进一步的随机对照试验,以巩固消融术作为PHN治疗的临床优势。
BACKGROUND: Radiofrequency thermocoagulation (RFT) of the thoracic nerve root is commonly employed in treating medication-refractory thoracic post-herpetic neuralgia (PHN). However, RFT procedures\' suboptimal pain relief and high occurrence of postoperative skin numbness present persistent challenges. Previous single-cohort research indicated that the low-temperature plasma coblation technique may potentially improve pain relief and reduce the incidence of skin numbness. Nevertheless, conclusive evidence favoring coblation over RFT is lacking.
OBJECTIVE: To compare the clinical outcomes associated with coblation to those associated with RFT in the treatment of refractory PHN.
METHODS: Retrospective matched-cohort study.
METHODS: Affiliated Hospital of Capital Medical University.
METHODS: Sixty-eight PHN patients underwent coblation procedures between 2019 and 2020, and 312 patients underwent RFT between 2015 and 2020 in our department. A matched-cohort analysis was conducted based on the criteria of age, gender, weight, pain intensity, pain duration, side of pain, and affected thoracic dermatome. Pain relief was assessed using the numeric rating scale (NRS), the Medication Quantification Scale (MQS) Version III and the Neuropathic Pain Symptom Inventory (NPSI), which were employed to indicate pain intensity, medication burden, and comprehensive pain remission at 6, 12, and 24 months. Numbness degree scale scores and complications were recorded to assess safety.
RESULTS: We successfully matched a cohort of 59 patients who underwent coblation and an equivalent number of patients who underwent RFT as a PHN treatment. At the follow-up time points, both groups\' NRS, MQS, and NPSI scores exhibited significant decreases from the pre-operation scores (P < 0.05). The coblation group\'s NRS scores were significantly lower than the RFT group\'s at the sixth and the twenty-fourth months (P < 0.05). At 24 months, the MQS values in the coblation group were significantly lower than those in the RFT group (P < 0.05). Furthermore, the coblation group\'s total intensity scores on the NPSI were significantly lower than the RFT group\'s at the 12- and 24-month follow-ups (P < 0.05). At 6 months, the coblation group\'s temporary intensity scores on the NPSI were significantly lower than the RFT group\'s (P < 0.05). Notably, the occurrence of moderate or severe numbness in the coblation group was significantly lower than in the RFT group at 6 and 12 months (P < 0.05). No serious adverse effects were reported during the follow-up.
CONCLUSIONS: This analysis was a single-center retrospective study with a small sample size.
CONCLUSIONS: In this matched cohort analysis, coblation achieved longer-term pain relief with a more minimal incidence rate of skin numbness than did RFT. Further randomized controlled trials should be conducted to solidify coblation\'s clinical superiority to RFT as a PHN treatment.