ABSTRACT
Objective:To examine the effect of minimally invasive radiofrequency(RF)thermocoagulation of the posterior medial branch of the spinal nerves on lumbar facet joint(LFJ)pain in the elderly.Methods:Patients over 60 years old with LFJ pain were randomly divided into an RF group and a control group.The primary outcome measures were the numerical rating scale(NRS)for pain assessment and the proportion of patients whose NRS decreased by 2 points or more, while the secondary outcome measures were the lumbar Oswestry dysfunction index(ODI), the proportion of patients whose ODI score decreased by 15 points or more, and the Macnab criteria.Results:Patients who met the inclusion criteria were divided into an RF group and a control group, with 135 patients in each group, including 171 women and 99 men.Compared with baseline values, changes in NRS scores in the RF group were significantly different from those in the control group at the 1st, 3rd and 6th months[(-2.3±1.1) vs.(-1.2±1.2), (-2.3±1.1) vs.(-1.2±1.2), (-2.3±1.1) vs.(-1.2±1.2), t=13.204, 16.366, 20.319, all P<0.001], and the proportions of patients whose NRS decreased by ≥2 at the 3rd and 6th months were higher in the RF group than in the control group[61.1%(80/131) vs.26.0%(32/123), 52.9%(64/121) vs.22.5%(25/111), χ2=18.287, 11.844, both P<0.001]. Compared with baseline values, there were also significant differences in ODI score changes between the RF group and the control group at the 1st, 3rd and 6th months[(-15.2±6.7) vs.(-10.1±7.4), (-14.6±6.8) vs.(-8.6±6.2), (-13.6±8.8) vs.(-7.7±9.2), t=5.563, 8.912, 7.721, all P<0.001], and the proportions of ODI reduction ≥15 were higher in the RF group than in the control group at the 3rd and 6th months[45.8%(60/131) vs.34.1%(42/123), 36.4%(44/121) vs.27.0%(30/111), χ2=6.668, 9.825, P=0.024, 0.031]. The proportions of patients achieving outcomes categorized as excellent and effective based on the Macnab criteria were significantly higher in the RF group than in the control group at the 6th month[60.3%(73/121) vs.36.0%(40/111), 81.0%(98/121) vs.54.1%(60/111), χ2=11.787, 8.890, both P<0.001)]. Conclusions:Minimally invasive radiofrequency thermocoagulation in the posterior medial branch of the spinal nerves can effectively reduce pain of the lumbar facet joints and improve movement disorders in the elderly, and the therapeutic effect is good 6 months after the procedure.
ABSTRACT
<p><b>OBJECTIVE</b>To observe therapeutic effect of acupuncture combined with antiemetic on cisplatin-induced nausea and vomiting.</p><p><b>METHODS</b>By using paired, cross-controlled trial design, 66 cases of chemotherapy were divided into group A and B, 33 cases in each group. For the group A, chemotherapy, tropisetron and acupuncture therapy were adopted in the first chemotherapy cycle and the same chemotherapy program, tropisetron and sham acupuncture were used in the next cycle. For the group B, chemotherapy, tropisetron and sham acupuncture were given in the first chemotherapy cycle and the same chemotherapy program, tropisetron and acupuncture therapy were applied in the next cycle. Zusanli (ST 36), Neiguan (PC 6) and Gongsun (SP 4) and auricular point Wei (stomach) were selected for acupuncture therapy, and the points at 3 cm lateral to Zusanli (ST 36) , Neiguan (PC 6) and Gongaun (SP 4) and auricular point corresponding to scapha level were selected for sham acupuncture. Acupuncture treatment or sham-acupuncture was given for 6 consecutive days, once each day and antiemetic tropisetron 5 mg was given to the two groups as basic antiemetic prophylaxis for 6 days, once daily. The therapeutic effects on nausea and vomiting in the 6 days were compared between the acupuncture group and the sham-acupuncture group in the two chemotherapeutic cycles.</p><p><b>RESULTS</b>The effective rates for nausea in the 2nd day and the 4th day were 87.1% and 79.0% in acupuncture group, which were superior to 59.4% and 57.8% in the sham-acupuncture group, respectively (both P < 0.05); and the therapeutic effects on vomiting in the 3rd-6th day in the acupuncture group were better than those in the sham-acupuncture group (P < 0.05).</p><p><b>CONCLUSION</b>Acupuncture combined with antiemetic can effectively decrease the incidence and degree of cisplatin-induced delayed nausea and vomiting. The effect of acupuncture is better than that of sham acupuncture.</p>