CT引导下经皮穿刺茎乳孔射频热凝治疗原发性面肌痉挛疗效分析  

CT-guided percutaneous puncture of stylomastoid foramen and radiofrequency ablation for treatment of primary hemifacial spasm

作　　者：黄冰 林慧丹 杜鑫丹 蒋佩龙 张利 江卫泽 黄浩 孙军锋 费勇 谢可越 姚明[1] Huang Bing;Lin Huidan;Du Xindan;Jiang Peilong;Zhang Li;Jiang Weizhe;Huang Hao;Sun Junfeng;Fei Yong;Xie Keyue;Yao Ming(Department of Pain Medicine, First Affiliated Hospital of Jiaxing College, Jiaxing 314000, China;Department of Pain Medicine, Ningbo First Hospital, Ningbo 315000, China;Department of Pain Medicine, Red Cross Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine, Hangzhou 310006, China;Department of Neurosurgery, Yinzhou Second Hospital of Ningbo City, Ningbo 315000, China;Department of Pain Medicine, Fuyang Central Hospital of Zhongtie, Fuyang 236000, China;Department of Pain Medicine, Second Affiliated Hospital of Zhejiang University, Hangzhou 310006, China)

机构地区：[1]嘉兴学院附属嘉兴市第一医院疼痛科,314000 [2]宁波市第一医院疼痛科,315000 [3]浙江中医药大学附属红会医院疼痛科,杭州310006 [4]宁波市鄞州二院神经外科,315000 [5]中国中铁阜阳中心医院疼痛科,阜阳236000 [6]浙江大学附属第二医院疼痛科,杭州310006

出　　处：《中华神经医学杂志》2019年第9期933-938,共6页Chinese Journal of Neuromedicine

基　　金：浙江省医药卫生平台重点项目(2016ZDA018).

摘　　要：目的观察CT引导下经皮穿刺茎乳孔射频热凝治疗原发性面肌痉挛的临床效果。方法嘉兴学院附属嘉兴市第一医院疼痛科自2018年8月至2019年6月采用CT引导下经皮穿刺茎乳孔射频热凝治疗原发性面肌痉挛患者27例,回顾性分析患者的临床资料和疗效。结果27例患者均在CT引导下将射频穿刺针准确穿刺至患侧茎乳孔,其中21例患者用0.5 mA以下电流能诱发患侧面肌出现与电刺激相同频率抽动,6例患者经调整穿刺针尖位置后也用0.5 mA以下电流诱发患侧面肌出现与电刺激相同频率抽动。1例患者以异常肌电反应(AMR)波消失为治疗结束标准,术后面肌痉挛部分缓解,无面瘫;26例患者以鼓腮稍漏气、闭眼时下眼睑稍费力为治疗结束标准,术后面肌痉挛均治愈,但遗留不同程度的面瘫(House-Brackmann分级Ⅱ级18例,Ⅲ级8例)。随访患者2~12个月,无面肌痉挛复发及面瘫加重现象。结论CT引导下经皮穿刺茎乳孔射频热凝可有效治疗原发性面肌痉挛,但会出现轻度面瘫。Objective To observe the clinical effect of CT-guided percutaneous puncture of stylomastoid foramen and radiofrequency ablation on primary hemifacial spasm. Methods Twenty-seven patients with primary hemifacial spasm, admitted to and accepted CT-guided percutaneous puncture of stylomastoid foramen and radiofrequency ablation in our hospital from August 2018 to May 2019, were chosen in our study. Clinical data and efficacy of the patients were retrospectively analyzed. Results All patients were punctured to the stylomastoid foramen precisely under the guidance of CT localization;21 could detect facial muscle twitch with 0.1-0.5 mA current, and positive results were also found in 6 patients with 0.5 mA current after adjusting the position of the needle tip. After standard radio frequency ablation (mean 83.3 ℃ for 23.7 seconds), 26 patients had complete disappearance of facial spasm, but left grade II (n=18) or grade III (n=8) facial paralysis;one patient with disappearance of abnormal electromyographic response waveform as the end criterion only partially relieved, but no facial paralysis. No facial hematoma, intracranial hemorrhage, infection, or death occurred. Follow-up for 2-12 months showed no recurrence or aggravation of facial paralysis. Conclusion CT-guided percutaneous puncture of stylomastoid foramen by radio frequency ablation can effectively treat primary hemifacial spasm, but there will be mild facial paralysis.

关 键 词：原发性面肌痉挛 茎乳孔 射频热凝 

分 类 号：R816[医药卫生—放射医学] R74[医药卫生—临床医学]