neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.17650/1683-3295-2020-22-1-49-55neurosurgery-834Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTРадиочастотная невротомия крестцово-подвздошного сочленения в лечении хронического пояснично-крестцового болевого синдромаRadiofrequency neurotomy of the sacroiliac joints in the treatment of chronic lumbosacral painhttps://orcid.org/0000-0002-6715-6021ЕвзиковГ. Ю.EvzikovG. Yu.

119021 Москва, ул. Россолимо, 11, стр. 1

Bld. 1, 11 Rossolimo St., Moscow 119021

mmaevzikov@mail.ruhttps://orcid.org/0000-0002-9833-5006БелозерскихК. А.BelozerskikhK. A.

119021 Москва, ул. Россолимо, 11, стр. 1

Bld. 1, 11 Rossolimo St., Moscow 119021

https://orcid.org/0000-0002-3188-6938ЕгоровО. Е.EgorovO. E.

119021 Москва, ул. Россолимо, 11, стр. 1

Bld. 1, 11 Rossolimo St., Moscow 119021

ПарфеновВ. А.ParfenovV. A.

119021 Москва, ул. Россолимо, 11, стр. 1

Bld. 1, 11 Rossolimo St., Moscow 119021

Клиника нервных болезней им. А. Я. Кожевникова Университетской клинической больницы № 3 ФГАОУ ВО Первый Московский государственный медицинский университет им. И. М. Сеченова Минздрава РоссииРоссияA. Ya. Kozhevnikov Clinic for Nervous Diseases, University Clinical Hospital No. 3, I. M. Sechenov First Moscow State Medical University, Ministry of Health of RussiaRussian Federation2020110420202214955Copyright © Евзиков Г.Ю., Белозерских К.А., Егоров О.Е., Парфенов В.А., 20202020Евзиков Г.Ю., Белозерских К.А., Егоров О.Е., Парфенов В.А.Evzikov G.Y., Belozerskikh K.A., Egorov O.E., Parfenov V.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/834

Цель исследования – сравнение эффективности различных методик радиочастотной денервации крестцово-подвздошного сочленения (КПС): стандартной невротомии (СН) задней медиальной ветви L5 и латеральных ветвей S1–S3, лигаментозной невротомии (ЛН) и сочетания лигаментозной и стандартной методик – комбинированной невротомии (КН).

Материалы и методы

Материалы и методы. Проведен анализ результатов лечения 311 пациентов с дисфункцией КПС. У 117 пациентов выполнена ЛН, у 102 – СН, у 92 – КН. Эффективность невротомии КПС оценена с помощью визуально-аналоговой шкалы (ВАШ) и индекса Освестри (Oswestry Disability Index) через 3 дня, 3, 6 и 12 мес после денервации.

Результаты и обсуждение

Результаты и обсуждение. Наиболее значительно улучшилось состояние пациентов после КН: средний индекс Освестри снизился с 35,14 ± 7,49 перед вмешательством до 22,64 ± 10,26 через 12 мес (р = 0,006). После СН и ЛН индекс Освестри уменьшился соответственно с 36,00 ± 7,32 до 28,08 ± 7,03 (р = 0,021) и с 34,50 ± 6,75 до 26,45 ± 7,18 (р = 0,018). Оценка интенсивности болевого синдрома по ВАШ после КН снизилась с 7,2 ± 2,0 до 3,6 ± 2,5 балла через 12 мес после денервации (p = 0,00024). После СН и ЛН интенсивность боли уменьшилась соответственно с 7,2 ± 2,0 до 4,8 ± 2,3 балла (p = 0,0025) и с 7,1 ± 2,3 до 5,7 ± 2,5 балла по ВАШ (p = 0,00016) через 12 мес после денервации.

Заключение

Заключение. Все методики невротомии при поражении КПС обеспечивают статистически значимое ослабление болевого синдрома и улучшение качества жизни пациентов. Положительный результат денервации сохраняется как минимум в течение 12 мес после вмешательства. КН приводит к более выраженному улучшению, и ее результаты превосходят результаты СН и ЛН на протяжении большей части периода послеоперационного наблюдения.

The study objective is to compare the effectiveness of different methods of radiofrequency denervation of the sacroiliac joint (SJ): standard neurotomy (SN) of the posterior medial branch L5 and lateral branches S1–S3, ligamentous neurotomy (LN) and a combination of ligamentous and standard methods – a combined neurotomy (CN).

Materials and methods

Materials and methods. The results of the treatment of 311 patients with SJ dysfunction were analyzed. LN was perfomed in 117 patients, SN – in 102, CN – in 92. The effectiveness of SJ neurotomy was assess using the visual-analog scale (WAS) and the Oswestry Disability Index (ODI) 3 days, 3, 6 and 12 months or more after denervation.

Results

Results. The most significant improving the patient’s condition occurred after CN, the average ODI decreased from 35.14 ± 7.49 before the intervention to 22.64 ± 10.26 a year after it (p = 0.006). After SN and LN, a decrease in the degree of maladaptation occurred, respectively, from 36.00 ± 7.32 to 28.08 ± 7.03 (p = 0.021) and from 34.50 ± 6.75 to 26.45 ± 7.18 (p = 0.018). The intensity of the pain syndrome according to WAS after CN decreased from 7.2 ± 2.0 to 3.6 ± 2.5 a year after denervation (p = 0,00024). After SN and LN, a decrease in pain intensity according to WAS occurred respectively from 7.2 ± 2.0 to 4.8 ± 2.3 (p = 0.0025) and from 7.1 ± 2.3 to 5.7 ± 2.5 (p = 0.00016) a year after denervation.

Conclusion

Conclusion. All methods of denervation in case of defeat of SJ lead to a statistically significant decrease in pain syndrome and an improvement in the quality of life. A positive result of denervation persists for a year after the intervention. CN leads to a more significant improvement and its results exceed the results of SN and LN for most of the period of postoperative observation.

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The authors declare that there are no conflicts of interest present.