CAJ | 학술논문

目的：探讨 C 型臂 X 光机引导穿刺联合神经电生理指导三叉神经半月节射频热凝术治疗三叉神经痛（TN）的效果。方法选取2013年6月—2014年9月于首都医科大学宣武医院行 C 型臂 X 光机引导穿刺三叉神经半月节射频热凝术治疗的 TN 患者110例。采用随机数字表法将患者分为试验组和对照组，各55例。C 型臂 X 光机扫描下确定卵圆孔，根据患者疼痛反应以及 X 线影像，调整射频针方向与深度，直至达卵圆孔内约3 mm。对照组根据给予电刺激时患者出现病变部位强烈的疼痛或感觉异常、肌肉抽动，确定针尖部位位于病变支。试验组分别于眶上孔、眶下孔、颏孔连接经皮记录电极，分别给予高、低频电刺激，多功能电流记录仪记录各支电位。以波幅较其他支波幅显著增高，确定针尖位置位于病变支。记录术后即刻、48 h 疼痛视觉模拟评分（VAS）、麻木 VAS 及范围、并发症发生情况。分别于术后第1周及第1、3、6个月进行电话随访，记录疼痛 VAS 评分、麻木范围及复发情况。对照组和试验组分别完整随访53、47例。结果试验组术后即刻疼痛消失患者比例高于对照组，差异有统计学意义（ P ﹤0.05）。两组术后48 h、1周及1、3、6个月疼痛消失患者比例比较，差异无统计学意义（P ﹥0.05）。试验组和对照组术后即刻麻木 VAS 分别为（7.3±1.4）、（8.5±1.5）分，差异有统计学意义（t ＝4.120，P ﹤0.001）。对照组术后即刻、48 h、1周及1、3个月麻木超出预期范围患者比例高于试验组，差异有统计学意义（P ﹤0.001）。对照组术后48 h 呕吐发生率高于试验组，差异有统计学意义（P ﹤0.05）。两组眩晕、恶心、复视、皮肤麻木及咀嚼肌无力发生率比较，差异均无统计学意义（P ﹥0.05）。对照组1例患者于术后2周复发，试验组随访期间无复发患者。两组复发率比较，差异无统计学意义（P ﹥0.05）。结论与电刺激患者反应引导穿刺技术比较，C 型臂 X 光机引导联合神经电生理指导射频卵圆孔穿刺，病变支定位准确性较好，术后麻木超出预期范围的风险降低。目的：探討 C 型臂 X 光機引導穿刺聯閤神經電生理指導三扠神經半月節射頻熱凝術治療三扠神經痛（TN）的效果。方法選取2013年6月—2014年9月于首都醫科大學宣武醫院行 C 型臂 X 光機引導穿刺三扠神經半月節射頻熱凝術治療的 TN 患者110例。採用隨機數字錶法將患者分為試驗組和對照組，各55例。C 型臂 X 光機掃描下確定卵圓孔，根據患者疼痛反應以及 X 線影像，調整射頻針方嚮與深度，直至達卵圓孔內約3 mm。對照組根據給予電刺激時患者齣現病變部位彊烈的疼痛或感覺異常、肌肉抽動，確定針尖部位位于病變支。試驗組分彆于眶上孔、眶下孔、頦孔連接經皮記錄電極，分彆給予高、低頻電刺激，多功能電流記錄儀記錄各支電位。以波幅較其他支波幅顯著增高，確定針尖位置位于病變支。記錄術後即刻、48 h 疼痛視覺模擬評分（VAS）、痳木 VAS 及範圍、併髮癥髮生情況。分彆于術後第1週及第1、3、6箇月進行電話隨訪，記錄疼痛 VAS 評分、痳木範圍及複髮情況。對照組和試驗組分彆完整隨訪53、47例。結果試驗組術後即刻疼痛消失患者比例高于對照組，差異有統計學意義（ P ﹤0.05）。兩組術後48 h、1週及1、3、6箇月疼痛消失患者比例比較，差異無統計學意義（P ﹥0.05）。試驗組和對照組術後即刻痳木 VAS 分彆為（7.3±1.4）、（8.5±1.5）分，差異有統計學意義（t ＝4.120，P ﹤0.001）。對照組術後即刻、48 h、1週及1、3箇月痳木超齣預期範圍患者比例高于試驗組，差異有統計學意義（P ﹤0.001）。對照組術後48 h 嘔吐髮生率高于試驗組，差異有統計學意義（P ﹤0.05）。兩組眩暈、噁心、複視、皮膚痳木及咀嚼肌無力髮生率比較，差異均無統計學意義（P ﹥0.05）。對照組1例患者于術後2週複髮，試驗組隨訪期間無複髮患者。兩組複髮率比較，差異無統計學意義（P ﹥0.05）。結論與電刺激患者反應引導穿刺技術比較，C 型臂 X 光機引導聯閤神經電生理指導射頻卵圓孔穿刺，病變支定位準確性較好，術後痳木超齣預期範圍的風險降低。
목적：탐토 C 형비 X 광궤인도천자연합신경전생리지도삼차신경반월절사빈열응술치료삼차신경통（TN）적효과。방법선취2013년6월—2014년9월우수도의과대학선무의원행 C 형비 X 광궤인도천자삼차신경반월절사빈열응술치료적 TN 환자110례。채용수궤수자표법장환자분위시험조화대조조，각55례。C 형비 X 광궤소묘하학정란원공，근거환자동통반응이급 X 선영상，조정사빈침방향여심도，직지체란원공내약3 mm。대조조근거급여전자격시환자출현병변부위강렬적동통혹감각이상、기육추동，학정침첨부위위우병변지。시험조분별우광상공、광하공、해공련접경피기록전겁，분별급여고、저빈전자격，다공능전류기록의기록각지전위。이파폭교기타지파폭현저증고，학정침첨위치위우병변지。기록술후즉각、48 h 동통시각모의평분（VAS）、마목 VAS 급범위、병발증발생정황。분별우술후제1주급제1、3、6개월진행전화수방，기록동통 VAS 평분、마목범위급복발정황。대조조화시험조분별완정수방53、47례。결과시험조술후즉각동통소실환자비례고우대조조，차이유통계학의의（ P ﹤0.05）。량조술후48 h、1주급1、3、6개월동통소실환자비례비교，차이무통계학의의（P ﹥0.05）。시험조화대조조술후즉각마목 VAS 분별위（7.3±1.4）、（8.5±1.5）분，차이유통계학의의（t ＝4.120，P ﹤0.001）。대조조술후즉각、48 h、1주급1、3개월마목초출예기범위환자비례고우시험조，차이유통계학의의（P ﹤0.001）。대조조술후48 h 구토발생솔고우시험조，차이유통계학의의（P ﹤0.05）。량조현훈、악심、복시、피부마목급저작기무력발생솔비교，차이균무통계학의의（P ﹥0.05）。대조조1례환자우술후2주복발，시험조수방기간무복발환자。량조복발솔비교，차이무통계학의의（P ﹥0.05）。결론여전자격환자반응인도천자기술비교，C 형비 X 광궤인도연합신경전생리지도사빈란원공천자，병변지정위준학성교호，술후마목초출예기범위적풍험강저。
Objective To investigate the effect of puncture guided by C - arm X - ray machine combining nerve electrophysiology in the treatment of trigeminal neuralgia ( TN ) by trigeminal semilunar ganglion radio frequency thermocoagulation. Methods We enrolled 110 TN patients who underwent trigeminal semilunar ganglion radio frequency thermocoagulation with puncture guided by C - arm X - ray machine in Xuanwu Hospital,Capital Medical University from June 2013 to September 2014. By random number table method,the subjects were divided into trial group and control group,with 55 patients in each group. Oval foramen was confirmed by the scan of C - arm X - ray machine,and the direction and depth of radio frequency needle were adjusted according to patients' pain reaction and X - ray image until the needle reached 3 mm inside oval foramen. For control group,whether the needle tip was positioned in lesion branch was determined by whether strong pain or paresthesia appeared and muscle twitch when electrical stimulation was given. For trial group,percutaneous recording electrodes were connected at supraorbital foramen,infraorbital foramen and mental foramen,after which high - frequency electrical stimulation and low - frequency electrical stimulation given,and electric potential of each branch was recorded by multi -functional galvo - recorder;whether the needle tip was located in lesion branch was determined by whether the wave amplitude of a branch was evidently higher than other branches. The VAS pain score,the VAS numbness score,the range of numbness and the incidence rates of complications were recorded immediately and 48 hours after surgery. Telephone follow - up was conducted 1 week,1 month,3 months and 6 months after surgery,during which the VAS pain score,range of numbness and relapse were recorded. The number of patients who completed the follow - up was 53 for control group and 47 for trial group. Results Trial group was higher(P ﹤ 0. 05)than control group in the proportion of patients whose pain disappeared immediately after surgery. The two groups were not significantly different(P ﹥ 0. 05)in the proportions of patients whose pain disappeared 48 hours,1 week,1 month,3 months and 6 months after surgery. The VAS score of immediate numbness was(7. 3 ± 1. 4)for trial group and(8. 5 ± 1. 5)for control group(t = 4. 120,P ﹤ 0. 001). Control group was higher than trial group in the proportions of patients whose numbness outreached the expected range immediately,48 hours,1 week,1 month and 3 months after surgery were higher than trial group(P ﹤ 0. 001). Control group was higher(P ﹤ 0. 05)than trial in the incidence of emesis 48 hours after surgery. The two groups were not significantly different(P ﹥ 0. 05)in the incidence of dizziness,nausea,diplopia,skin numbness and masticatory muscle weakness. One patient in control group relapsed after surgery,and no patient relapsed during follow - up in trial group. The two groups were not significantly different in recurrence rate(P ﹥ 0. 05). Conclusion Compared with puncture guided by patients' response to electric stimulation,oval foramen puncture guided by C - arm X - ray machine combining nerve electrophysiology is more accurate in the positioning of lesion branch and leads to lower risk in numbness outreaching expected range after surgery.