人体脊柱胸段背根神经节射频消融穿刺途径优化研究
发布时间：2019-03-03 19:38
【摘要】：目的：对比分析不同穿刺路径对脊柱胸段不同位置类型背根神经节（dorsal root ganglion, DRG）进行射频消融的毁损率，确定脊柱胸段不同位置类型DRG的最佳射频穿刺途径。 方法：根据穿刺和消融毁损途径的不同将14具胸段脊柱标本随机分为三组（A组为仅采用经椎间孔途径穿刺组，2具，共48个DRG；B组据DRG分型且采用相应单一穿刺途径组，6具，，共144个DRG；C组据DRG分型且采用双路穿刺途径组，6具，共144个DRG），A、B、C三组的DRG再根据DRG位置类型分为椎间孔外型亚组、椎间孔型亚组、椎管内型亚组，分别采用相应经皮穿刺路径进行DRG射频毁损；以病理结果为判定标准，对不同穿刺路径的毁损效果进行对比分析。 结果：A组中，椎间孔外型亚组（DRG共29个）、椎间孔型亚组（DRG共12个）及椎管内型亚组（DRG共7个）的射频毁损率分别为72.58±18.88%、54.16±24.84%及32.85±28.11%，P0.05；B组中，经小关节突外侧缘途径（DRG共43个）及经椎间孔途径（DRG共45个）穿刺椎间孔外型亚组的射频毁损率分别为71.86±15.15%及72.02±17.86%；经椎间孔途径（DRG共14个）及经椎板切迹途径（DRG共16个）穿刺椎间孔型亚组的射频毁损率分别为57.14±18.02%及52.47±20.64%；经小关节突内侧缘途径（DRG共12个）及经椎板切迹途径（DRG共14个）穿刺椎管内型亚组的射频毁损率分别为68.75±14.63%及71.78±16.00%；C组中，椎间孔外型亚组采用经小关节突外侧缘途径联合经椎间孔途径穿刺DRG共69个，射频毁损率82.46±14.10%；椎间孔型亚组采用经椎间孔途径联合经椎板切迹途径穿刺DRG共39个，射频毁损率81.53±11.81%；椎管内型亚组采用经小关节突内侧缘途径联合经椎板切迹途径穿刺DRG共36个，射频毁损率80.83±13.33%。A、C两组间及B、C两组间不同位置类型DRG毁损率对比均有显著性差异（P0.05）。 结论：DRG穿刺途径单一是目前胸段DRG射频消融效果不佳的重要原因之一；根据DRG不同位置类型采用双路联合穿刺路径可显著提高DRG射频毁损率。
[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 卤18.88%, 54.16 卤24.84% and 32.85 卤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 卤15.15% and 72.02 卤17.86%, respectively. The radiofrequency destruction rate of transforaminal approach (14 DRG) and translaminar notch (16 DRG) was 57.14 卤18.02% and 52.47 卤20.64%, respectively. The radiofrequency lesion rates in the intraspinal canal subgroup were 68.75 卤14.63% and 71.78 卤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 卤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 卤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 卤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]
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.8
本文编号：2434029
[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 卤18.88%, 54.16 卤24.84% and 32.85 卤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 卤15.15% and 72.02 卤17.86%, respectively. The radiofrequency destruction rate of transforaminal approach (14 DRG) and translaminar notch (16 DRG) was 57.14 卤18.02% and 52.47 卤20.64%, respectively. The radiofrequency lesion rates in the intraspinal canal subgroup were 68.75 卤14.63% and 71.78 卤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 卤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 卤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 卤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]
【学位授予单位】：川北医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.8
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