脉冲射频联合神经阻滞治疗颈神经根病的疗效与安全性：系统评价与荟萃分析。
完整摘要 · 中文译文
背景：颈神经根病是颈肩臂痛及功能障碍的常见原因。尽管神经阻滞可提供快速镇痛，但其持久性可能有限。本系统评价和荟萃分析评估了脉冲射频联合神经阻滞是否比单独神经阻滞具有更优的疗效和相当的安全性。 方法：检索了自建库至2026年4月10日的8个数据库。纳入比较脉冲射频联合神经阻滞与单独神经阻滞治疗成人颈神经根病或颈神经根性疼痛的随机对照试验。使用RevMan 5.4进行荟萃分析。计算风险比或均数差及其95%置信区间。 结果：共纳入9项随机对照试验，涉及783例患者。与单独神经阻滞相比，联合治疗显著提高了总体临床有效率（RR = 1.13，95% CI：1.05-1.22），降低了VAS评分测量的疼痛强度（MD = -0.87，95% CI：-1.27至-0.47），增加了颈椎屈伸活动范围（MD = 8.56，95% CI：1.67-15.44），并改善了田中靖久症状评分（MD = 2.61，95% CI：1.81-3.40）。不良反应方面差异无统计学意义（RR = 0.96，95% CI：0.52-1.78）。 讨论：脉冲射频联合神经阻滞可能比单独神经阻滞提供更大的疼痛缓解和更好的总体临床反应，且不增加短期不良反应。然而，关于功能改善的证据仍不确定。合并疼痛差异仍不明确。 作为适度改善，功能性结局得到少数研究的支持，并且现有证据并未确立在报告随访期之外的持久获益。需要进一步的高质量多中心试验来确认长期疗效、阐明功能性获益，并优化治疗方案。 系统综述注册：https://www.crd.york.ac.uk/PROSPERO/view/CRD420251271276，注册号：CRD420251271276。
完整摘要 · 英文原文
BACKGROUND: Cervical radiculopathy is a common cause of neck-shoulder-arm pain and functional impairment. Although nerve block provides rapid analgesia, its durability may be limited. This systematic review and meta-analysis evaluated whether pulsed radiofrequency combined with nerve block offers superior efficacy and comparable safety to nerve block alone. METHODS: Eight databases were searched from inception to April 10, 2026. Randomized controlled trials comparing pulsed radiofrequency plus nerve block with nerve block alone in adults with cervical radiculopathy or cervical nerve root pain were included. Meta-analysis was performed using RevMan 5.4. Risk ratios or mean differences with 95% confidence intervals were calculated. RESULTS: Nine randomized controlled trials involving 783 patients were included. Compared with nerve block alone, combined therapy significantly improved the overall clinical response rate (RR = 1.13, 95% CI: 1.05-1.22), reduced pain intensity measured by VAS score (MD = -0.87, 95% CI: -1.27 to -0.47), increased cervical flexion-extension range of motion (MD = 8.56, 95% CI: 1.67-15.44), and improved Yasuhisa Tanaka symptom scores (MD = 2.61, 95% CI: 1.81-3.40). No significant difference was observed in adverse reactions (RR = 0.96, 95% CI: 0.52-1.78). DISCUSSION: Pulsed radiofrequency combined with nerve block may provide greater pain relief and better overall clinical response than nerve block alone without increasing short-term adverse reactions. Nevertheless, the evidence for functional improvement remains uncertain. The pooled pain difference was modest, functional outcomes were supported by few studies, and the available evidence does not establish durable benefit beyond the reported follow-up periods. Further high-quality multicenter trials are needed to confirm long-term efficacy, clarify functional benefits, and optimize treatment protocols. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251271276, Identifier: CRD420251271276.