眶上孔变异情况对射频治疗原发性三叉神经V1支疼痛的影响  

Effect of supraorbital foramen variation on radiofrequency treatment of primary trigeminal neuralgia V1

作　　者：叶钢 谢可越 黄兵[2] 姚明[2] 冯智英[1] Ye Gang;Xie Keyue;Huang Bing;Yao Ming;Feng Zhiying(Department of Pain Management,the First Affiliated Hospital of Zhejiang University,Hangzhou 310000,China;Department of Pain Management,the First Affiliated Hospital of Jiaxing University,Jiaxing 314000,China)

机构地区：[1]浙江大学医学院附属第一医院疼痛科,杭州310000 [2]嘉兴学院附属第一医院疼痛科,嘉兴314000

出　　处：《中华医学杂志》2020年第7期527-532,共6页National Medical Journal of China

基　　金：浙江省自然科学基金(LY16H090016);浙江省医药卫生平台重点课题(2016ZDA018);嘉兴市科技厅项目(2017BY18001)。

摘　　要：目的比较不同眶上孔变异情况对射频治疗三叉神经V1支疼痛临床疗效的影响。方法回顾性分析浙江省嘉兴市第一医院2011年2月至2017年8月原发性三叉神经V1支疼痛择期行CT引导下眶上神经射频热凝术的62例患者临床资料。根据患侧眶上孔形态,将患者分为有孔组(n=28)和切迹组(n=34)。记录两组患者年龄、性别、病程时间、CT扫描次数,统计分析术前、术后1 d、术后6个月、术后1年、术后2年疼痛数字评分(NRS)的平均秩次和有效率(NRS≤1分为有效),以及术后1 d、术后2年麻木程度的差异。并随访记录患者术后出现的近期和远期并发症。结果两组患者的年龄、性别、病程时间、CT扫描次数、术前NRS、术后各时间点NRS等差异均无统计学意义(均P>0.05)。与术前NRS相比,两组患者术后各时间点NRS的平均秩次值均明显下降,差异均有统计学意义(均P<0.05)。有孔组术后1 d的Ⅰ、Ⅱ、Ⅲ、Ⅳ级麻木发生率分别为0、53.6%、46.4%和0,术后2年分别为42.9%、46.4%、10.7%和0;切迹组术后1 d的Ⅰ、Ⅱ、Ⅲ、Ⅳ级麻木发生率分别为0、29.4%、67.6%和2.9%,术后2年分别为55.9%、38.2%、5.9%和0;两组患者术后2年麻木程度较术后1 d麻木程度均有所减轻,差异均有统计学意义(均P<0.05)。有孔组与切迹组患者术后2年有效率分别为78.6%和52.9%,差异有统计学意义(χ2=4.406,P<0.05)。患者在术后除不同程度的穿刺点肿胀外,无其他近期及远期严重并发症。结论对于不同解剖变异类型,眶上孔射频治疗三叉神经V1支疼痛的近期和远期有效率均较高;有孔型眶上孔远期有效率更高,除麻木外,无其他严重的不良反应,患者接受度较高。Objective To compare the effect of different supraorbital foramen variations on the clinical efficacy of radiofrequency treatment of primary trigeminal neuralgia V1.Methods The clinical data of 62 patients with primary trigeminal neuralgia (V1 branch) from February 2011 to August 2017 in the first hospital of Jiaxing were analyzed retrospectively. According to the shape of supraorbital foramen, the patients were divided into foramen group (n=28) and incisional group (n=34). The age, sex, course time, CT scan times of the two groups were recorded, and the mean rank of NRS scores and effective rates (NRS≤1) before operation, 1 day after operation, 6 months after operation, 1 year after operation and 2 years after operation were statistically analyzed, as well as the difference of numbness degree in 1 day and 2 years after operation. The short-term and long-term complications were recorded.Results There was no significant difference in age, gender, course time, CT scan times, preoperative NRS and postoperative NRS between the two groups (P>0.05). Compared with the preoperative, the mean rank of NRS in the two groups decreased significantly at each postoperative time point, and the difference was statistically significant (all P<0.05). Foramen group of postoperative 1 d Ⅰ, Ⅱ, Ⅲ, Ⅳ numbness rate were 0, 53.6%, 46.4% and 0 respectively, after 2 years were 42.9%, 46.4%, 10.7% and 0 respectively. Incisional group of postoperative 1 d Ⅰ, Ⅱ, Ⅲ, Ⅳ numbness rate were 0, 29.4%, 67.6% and 2.9% respectively, after 2 years were 55.9%, 38.2%, 5.9% and 0 respectively. The degree of numbness 2 years after the operation was reduced in both groups compared with that 1 day after the operation, and the difference was statistically significant (all P<0.05). The effective rates of the foramen group and the incisional group were 78.6% and 52.9%, respectively, with statistically significant differences (χ2=4.406, P<0.05) . The patient had no other serious complications in the near and long term except for the swelling of

关 键 词：三叉神经痛 射频 眶上孔 

分 类 号：R74[医药卫生—神经病学与精神病学]