發(fā)布時間：2019-03-03 19:38

【摘要】：目的：對比分析不同穿刺路徑對脊柱胸段不同位置類型背根神經(jīng)節(jié)（dorsal root ganglion, DRG）進行射頻消融的毀損率，確定脊柱胸段不同位置類型DRG的最佳射頻穿刺途徑。 方法：根據(jù)穿刺和消融毀損途徑的不同將14具胸段脊柱標本隨機分為三組（A組為僅采用經(jīng)椎間孔途徑穿刺組，2具，共48個DRG；B組據(jù)DRG分型且采用相應單一穿刺途徑組，6具，，共144個DRG；C組據(jù)DRG分型且采用雙路穿刺途徑組，6具，共144個DRG），A、B、C三組的DRG再根據(jù)DRG位置類型分為椎間孔外型亞組、椎間孔型亞組、椎管內型亞組，分別采用相應經(jīng)皮穿刺路徑進行DRG射頻毀損；以病理結果為判定標準，對不同穿刺路徑的毀損效果進行對比分析。 結果：A組中，椎間孔外型亞組（DRG共29個）、椎間孔型亞組（DRG共12個）及椎管內型亞組（DRG共7個）的射頻毀損率分別為72.58±18.88%、54.16±24.84%及32.85±28.11%，P0.05；B組中，經(jīng)小關節(jié)突外側緣途徑（DRG共43個）及經(jīng)椎間孔途徑（DRG共45個）穿刺椎間孔外型亞組的射頻毀損率分別為71.86±15.15%及72.02±17.86%；經(jīng)椎間孔途徑（DRG共14個）及經(jīng)椎板切跡途徑（DRG共16個）穿刺椎間孔型亞組的射頻毀損率分別為57.14±18.02%及52.47±20.64%；經(jīng)小關節(jié)突內側緣途徑（DRG共12個）及經(jīng)椎板切跡途徑（DRG共14個）穿刺椎管內型亞組的射頻毀損率分別為68.75±14.63%及71.78±16.00%；C組中，椎間孔外型亞組采用經(jīng)小關節(jié)突外側緣途徑聯(lián)合經(jīng)椎間孔途徑穿刺DRG共69個，射頻毀損率82.46±14.10%；椎間孔型亞組采用經(jīng)椎間孔途徑聯(lián)合經(jīng)椎板切跡途徑穿刺DRG共39個，射頻毀損率81.53±11.81%；椎管內型亞組采用經(jīng)小關節(jié)突內側緣途徑聯(lián)合經(jīng)椎板切跡途徑穿刺DRG共36個，射頻毀損率80.83±13.33%。A、C兩組間及B、C兩組間不同位置類型DRG毀損率對比均有顯著性差異（P0.05）。 結論：DRG穿刺途徑單一是目前胸段DRG射頻消融效果不佳的重要原因之一；根據(jù)DRG不同位置類型采用雙路聯(lián)合穿刺路徑可顯著提高DRG射頻毀損率。
[Abstract]:Aim: to compare and analyze the radiofrequency ablation rate of radiofrequency ablation (RFCA) on (dorsal root ganglion, DRG) of different position types of dorsal root ganglion (DRG) of spine and thoracic segment by different puncture paths, and to determine the best way of radiofrequency puncture of DRG of different location types of spine and chest segment. Methods: according to the different approaches of puncture and ablation, 14 thoracic spine specimens were randomly divided into three groups (group A: transforaminal puncture only, 2 cases, total 48 DRG;). Group B according to DRG classification and the corresponding single puncture approach group, 6 cases, a total of 144 DRG; According to DRG classification and two-way puncture approach group, 6 patients in group C had 144 DRG), A, B, C groups DRG were divided into extraforaminal subgroup, intervertebral foraminal subgroup and intraspinal type subgroup according to DRG location type, and the patients in group C were divided into three groups according to the location type of DRG, the type of intervertebral foramen and the subgroup of intraspinal canal. The corresponding percutaneous puncture path was used for radiofrequency ablation of DRG. According to the pathological results, the damage effects of different puncture paths were compared and analyzed. Results: in group A, the radio frequency lesion rates were 72.58 鹵18.88%, 54.16 鹵24.84% and 32.85 鹵28.11% in the extraforaminal subgroup (29 DRG), the intervertebral foramen subgroup (DRG 12) and the intraspinal subgroup (DRG 7), respectively. P0.05; In group B, the radiofrequency destruction rate of extraforaminal approach (DRG 43) and transforaminal pathway (DRG 45) were 71.86 鹵15.15% and 72.02 鹵17.86%, respectively. The radiofrequency destruction rate of transforaminal approach (14 DRG) and translaminar notch (16 DRG) was 57.14 鹵18.02% and 52.47 鹵20.64%, respectively. The radiofrequency lesion rates in the intraspinal canal subgroup were 68.75 鹵14.63% and 71.78 鹵16.00%, respectively, through the medial border approach of facet process (12 DRG) and the laminar notch approach (14 DRG). In group C, 69 DRG were performed through the lateral edge of facet process and transforaminal approach, and the radio-frequency lesion rate was 82.46 鹵14.10%. In the intervertebral foraminal subgroup, 39 DRG were punctured by transforaminal approach combined with laminar notch approach, and the radio-frequency lesion rate was 81.53 鹵11.81%. In the intraspinal subgroup, 36 DRG were punctured via the medial edge of facet process combined with laminar notch approach, and the radiofrequency lesion rate was 80.83 鹵13.33%. There was significant difference in the DRG damage rate between the two groups in different position types (P0.05). Conclusion: the single approach of DRG puncture is one of the important reasons for the poor radiofrequency ablation of thoracic DRG at present, and two-way combined puncture pathway according to the different location types of DRG can significantly improve the rate of radiofrequency ablation of DRG. [WT5 "HZ] conclusion: [WT5" BZ]
【學位授予單位】：川北醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2013
【分類號】：R816.8

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