微创医学

目的观察C型臂X光机引导下脊神经后内侧支损毁术治疗青少年峡部裂所致腰痛的临床效果。方法回顾性分析2022年2月至2022年12月在广西中医药大学第一附属医院脊柱外科住院治疗的30例青少年腰椎峡部裂患者的临床资料，其中在X线透视下给予损毁患处脊神经后内侧支进行治疗的15例患者设为射频组，同期接受曲安奈德注射液、利多卡因注射液混合液患处注射治疗，且性别、年龄等一般资料与射频组均衡可比的15例纳入局封组。记录并比较两组患者的一般资料、治疗前后的腰痛视觉模拟量表（VAS）评分、Oswestry功能障碍指数（ODI）评分及改良Macnab疗效评分等指标。结果所有患者均顺利完成手术。两组患者的VAS评分差异有统计学意义（F组间=1 501.11，P<0.001），两组患者的VAS评分随时间延长呈现降低趋势（F时间=4 560.97，P<0.001），干预措施和随访时间存在交互效应（F交互=474.54，P<0.05）；两组患者的ODI评分差异有统计学意义（F组间=334.93，P<0.01），两组患者的ODI评分随时间延长呈现降低趋势（F时间=276.93，P<0.01），组别和随访时间存在交互效应（F交互=115.41，P<0.001）。在改良Macnab疗效评分方面射频组疗效优于局封组（P<0.05）。结论 C型臂X光机引导下脊神经后内侧支损毁术治疗青少年峡部裂所致腰痛，具有安全、有效、快速康复的特点，值得临床推广。

Objective To evaluate the clinical effect for ablation of posterior medial branch of the spinal nerve guided by C-arm X-ray machine in the treatment of lumbago caused by spondylolysis in adolescents. Methods A retrospective analysis was conducted on the clinical data of 30 adolescent patients with lumbar spondylolysis who were hospitalized in the department of spinal surgery of the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine from February 2022 to December 2022. Among them, 15 patients who underwent ablation of the posterior medial branch of the spinal nerve at the affected site under X-ray fluoroscopy were designated as the radiofrequency group. During the same period, 15 patients who received mixed injection of triamcinolone acetonide injection and lidocaine injection at the affected site, with comparable general data (such as gender and age) to the radiofrequency group, were included in the local block group. The general data of the two groups, as well as the Visual Analogue Scale (VAS) scores for lumbargo, Oswestry Disability Index (ODI) scores, and modified Macnab efficacy scores before and after treatment were recorded and compared. Results All patients successfully completed the surgery. There was a statistically significant difference in VAS scores between the two groups (Finter-group=1 501.11，P<0.001). The VAS scores of both groups showed a decreasing trend with the prolongation of time (Ftime=4 560.97，P<0.001), and there was an interaction effect between intervention measures and follow-up time (Finteraction=474.54，P<0.05). There was a statistically significant difference in ODI scores between the two groups (Finter-group=334.93，P<0.01). The ODI scores of both groups showed a decreasing trend with the prolongation of time (Ftime=276.93，P<0.01), and there was an interaction effect between group and follow-up time (Finteraction=115.41，P<0.001). In terms of the modified Macnab efficacy score, the radiofrequency group showed better efficacy than the local block group (P<0.05). Conclusion Ablation of the posterior medial branch of the spinal nerve guided by C-arm X-ray machine for lumbago caused by spondylolysis in adolescents is safe, effective, and conducive to rapid rehabilitation, making it worthy of clinical promotion.