摘要
目的探讨脊髓电刺激(SCS)治疗会阴痛的长期疗效及安全性。方法回顾性分析自2015年1月至2019年1月于首都医科大学宣武医院功能神经外科采用SCS治疗的会阴痛患者9例,患者表现为肛周会阴区域疼痛,视觉模拟评分(VAS)>5分,病史>1年,既往治疗效果不佳。一期测试采用胸腰段椎板间隙入路,脊髓硬膜外置入SCS电极,然后进行体外程控测试;一期测试有效的患者二期手术置入脉冲发生器(IPG),置入IPG患者采用门诊和电话随访,以VAS改善率评估手术前后疼痛改善程度,分析SCS治疗慢性会阴痛的长期效果和并发症情况。结果9例会阴痛患者中,会阴区域手术后5例,腰椎骨折后2例,无明确病因2例。SCS一期测试有效后植入IPG长期治疗患者7例,测试有效率77.8%(7/9例)。7例SCS长期治疗患者中,VAS评分术后1年较术前低,差异有统计学意义[(2.0±0.8)比(8.6±1.0)分,t=12.051,P<0.001],VAS评分整体改善率75.9%。随访期间1例患者出现脉冲发生器植入部位积液感染,未见电极及延长线折断、脊髓硬膜外血肿、脊髓或神经根损伤等并发症。结论慢性会阴痛SCS测试治疗有效率高,SCS永久植入后疼痛缓解长期效果良好,安全性较高。
Objective To investigate the long-term efficacy and safety of spinal cord stimulation(SCS)in the treatment of patients with perineum pain.Methods Nine patients with perineum pain treated by SCS in the Functional Neurosurgery Department of Xuanwu Hospital Affiliated to Capital Medical University were analyzed from January 2015 to January 2019 retrospectively.The patients showed perianal or perineum pain.Visual analogue scale(VAS)>5 and the history was more than 1 year,with poor previous treatment effect.In the first phase of SCS trial test,the thoracolumbar interlaminar approach was adopted,the SCS electrode was introduced into the spinal epidural space,then the program-controlled test in vitro was conducted afterwards.In the second phase of the treatment,the implantable impulse generator(IPG)was implanted in patients with good trial test effect,and the implanted IPG patients were followed up by outpatient department and telephone.The improvement rate of VAS was used to evaluate the pain improvement.The long-term effect and complications were analyzed.Results Nine patients with perineum pain were included,among them 5 cases with previous operation in perineum area,2 cases after lumbar fracture,2 cases without definite causes.Seven patients were treated with IPG implantation after success SCS trial test,and the effective rate of SCS trial was 77.8%(7/9 cases).Among the 7 patients with long-term treatment of SCS,VAS was significantly decreased at 1 year after the operation compared with preoperation[(2.0±0.8)vs.(8.6±1.0),t=12.051,P<0.001],and the total pain improvement rate was 75.9%.During the follow-up period,one patient had refractory effusion at the implantation site of pulse generator.There were no electrode or extension line breaking,spinal epidural hematoma,spinal cord or nerve root injury and other serious complications.Conclusion The effective rate of SCS trial test is high,and the long-term efficacy and safety of SCS are good in the treatment of patients with chronic perineum pain.
作者
倪兵
朱宏伟
郭松
任志伟
舒伟
胡永生
李勇杰
Ni Bing;Zhu Hongwei;Guo Song;Ren Zhiwei;Shu Wei;Hu Yongsheng;Li Yongjie(Department of Functional Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing Institute of Functional Neurosurgery,Beijing City 100053,China)
出处
《中华疼痛学杂志》
2020年第6期491-496,共6页
Chinese Journal Of Painology
关键词
电刺激
脊髓
会阴痛
神经痛
Electric stimulation
Spinal cord
Perineum pain
Neuralgia