CAJ | 학술논문

目的探讨以岩尖三叉神经半月节压迹为定位标记在原发性三叉神经痛射频热凝治疗中的应用及疗效.方法回顾性分析南通大学附属建湖医院神经外科自2009年8月至2012年9月收治的43例原发性三叉神经痛患者资料,根据定位标记不同分为卵圆孔组(21例)及半月节压迹组(22例).2组患者均经Hartel前入路,卵圆孔组经卵圆孔穿刺,调整穿刺深度,方波验证后热凝毁损;半月节压迹组以岩尖三叉神经半月节压迹为定位标记进行内定位.横向定位:下颌神经痛以压迹外1/3为靶点,上颌神经痛以压迹中1/3为靶点,眼神经痛以压迹内1/3为靶点;前后定位:以压迹骨面前方5mm以内为靶点.以穿刺时间衡量穿刺难度,比较2组穿刺难度、穿刺成功率和相关并发症发生率,记录术后1d、1个月、6个月、12个月、24个月时视觉模拟(VAS)评分并评估镇痛效果.结果 2组患者穿刺成功率均为100％.卵圆孔组穿刺时间为(5.0±0.4) min,半月节压迹组穿刺时间为(12.0±0.7)min,差异有统计学意义(P＜0.05).卵圆孔组穿刺并发症(皮下血肿)发生率低于半月节压迹组4.8％、13.6％,差异有统计学意义(P＜0.05).卵圆孔组射频并发症高于半月节压迹组,其中2组患者射频热凝累及正常三叉神经分支比例分别为42.9％％、13.6％,差异有统计学意义(P＜0.05),累及运动纤维比例分别为14.3％、4.5％,差异有统计学意义(P＜0.05);2组患者术后12、24个月时疗效差异有统计学意义(P＜0.05).结论岩尖三叉神经半月节压迹内定位射频热凝治疗三叉神经痛具有射频并发症少、远期疗效好等优势,但对穿刺技术要求相对较高.
목적 탐토이암첨삼차신경반월절압적위정위표기재원발성삼차신경통사빈열응치료중적응용급료효.방법 회고성분석남통대학부속건호의원신경외과자2009년8월지2012년9월수치적43례원발성삼차신경통환자자료,근거정위표기불동분위란원공조(21례)급반월절압적조(22례).2조환자균경Hartel전입로,란원공조경란원공천자,조정천자심도,방파험증후열응훼손;반월절압적조이암첨삼차신경반월절압적위정위표기진행내정위.횡향정위:하합신경통이압적외1/3위파점,상합신경통이압적중1/3위파점,안신경통이압적내1/3위파점;전후정위:이압적골면전방5mm이내위파점.이천자시간형량천자난도,비교2조천자난도、천자성공솔화상관병발증발생솔,기록술후1d、1개월、6개월、12개월、24개월시시각모의(VAS)평분병평고진통효과.결과 2조환자천자성공솔균위100％.란원공조천자시간위(5.0±0.4) min,반월절압적조천자시간위(12.0±0.7)min,차이유통계학의의(P＜0.05).란원공조천자병발증(피하혈종)발생솔저우반월절압적조4.8％、13.6％,차이유통계학의의(P＜0.05).란원공조사빈병발증고우반월절압적조,기중2조환자사빈열응루급정상삼차신경분지비례분별위42.9％％、13.6％,차이유통계학의의(P＜0.05),루급운동섬유비례분별위14.3％、4.5％,차이유통계학의의(P＜0.05);2조환자술후12、24개월시료효차이유통계학의의(P＜0.05).결론 암첨삼차신경반월절압적내정위사빈열응치료삼차신경통구유사빈병발증소、원기료효호등우세,단대천자기술요구상대교고.
Objective To study the ovale or trigeminal notch positioning and puncture techniques using thin slice CT scan in treatment of trigeminal neuralgia through radiofrequency thermocoagulation,and analyze its efficacy.Methods The clinical data of 43 patients with primary trigeminal neuralgia,admitted to our hospital from August 2009 to September 2012,were retrospectively analyzed.According to the positioning marks,two groups were divided.Both group A (n=21) and group B (n=22) adopted Hartel anterior approach;puncture in group A was through foramen ovale,adjusting the direction and depth of the puncture needle,observing the patient's response to electrical stimulation,and damaging the sensory fiber;puncture in B group was through trigeminal gasserian ganglion notch,damaging neurons through radiofrequency thermocoagulation.Transverse and longitudinal positioning was performed in the two groups,and mandibular neuralgia,maxillary neuralgia and ophthalmic neuralgia were located in the trigeminal notch from outside to inside,and the longitudinal location targeted in the trigeminal notch bone surface in front of 5 mm.The puncturing time,puncturing success rate and complications rate between the two groups were recorded.The visual analog scale (VAS) was scored,respectively,one d,and one,6,12 and 24 months after the surgery.The outcome responses of pain relief were evaluated.Results The puncture success rate in both two groups was 100％;the puncturing time in group A ([5.0±0.4] min) was significantly shorter than that in group B ([12.0±0.7] min,P＜0.05);the puncturing complication rate in group A (4.8％) was significantly lower than that in group B (13.6％,P＜0.05),but the complication rate ofradiofrequency in group A was significantly higher than that in group B (involving normal nervi trigeminus branches:42.9％ vs.13.6％,involving motor fibers:14.3％ vs.4.5％,P＜0.05).The treatment effect of group B was better than that group A 12 and 24 months after surgery (P＜0.05).Conclusions A new method of radiofrequency thermocoagulation targeted pathogenic neurons in trigeminal notch owes more advantages,including low complication rate caused by radiofrequency thermocoagulationa,high target selectivity and low recurrence rate.However,its technical requirement is high.