CT三维重建下脉冲射频治疗顽固性面肌痉挛的临床效果  

Clinical efficacy of pulsed radiofrequency guided by CT three-dimentional reconstruction in treating intractable hemifacial spasm

作　　者：李丽梅[1] 张志利[1] 刘晓东[2] 徐幼苗[1] 杨旭[1] 董蕊[1] 刘悦[1] LI Li-mei;ZHANG Zhi-li;LIU Xiao-dong;XU You-miao;YANG Xu;DONG Rui;LIU Yue(Department of Pain Treatment,First Hospital of Qinhuangdao,Qinhuangdao Hebei 066000,China;First Department of Ultrasonic Diagnosis,First Hospital of Qinhuangdao,Qinhuangdao Hebei 066000,China)

机构地区：[1]秦皇岛市第一医院疼痛科,河北秦皇岛066000 [2]秦皇岛市第一医院超声诊断一科,河北秦皇岛066000

出　　处：《局解手术学杂志》2020年第8期657-661,共5页Journal of Regional Anatomy and Operative Surgery

基　　金：秦皇岛市重点研发计划科技支撑项目(201902A181)。

摘　　要：目的探讨CT三维重建下脉冲射频治疗顽固性面肌痉挛的临床效果及其安全性和有效性。方法回顾性分析2014年12月至2018年12月就诊于秦皇岛市第一医院疼痛科的40例顽固性面肌痉挛患者的临床资料,按照手术方法不同将其分为脉冲射频组和神经阻滞组,每组20例。脉冲射频组采用CT三维重建下脉冲射频术;神经阻滞组先采用超声引导下行茎乳孔区面神经阻滞,每5 d注射1次,共3次,然后超声引导下行星状神经节阻滞,每天阻滞1次,左右交替共10次。记录2组患者术后15 d、3个月、1年时Cohen分级和治愈率,记录术后3个月、1年时复发率及不良反应发生情况。结果术后15 d,2组患者Cohen分级、治愈率比较,差异无统计学意义(P> 0.05)。与神经阻滞组比较,脉冲射频组患者术后3个月、1年Cohen分级明显较低,治愈率较高(P <0.05),且无明显不良反应发生。结论顽固性面肌痉挛患者应用脉冲射频较单纯神经阻滞治疗临床效果更佳,在三维CT影像引导下进行治疗,具有定位精准、安全性高等特点,为面肌痉挛提供了一种安全、可行的治疗方法。Objective To evaluate the safety and efficacy of pulsed radiofrequency guided by CT three-dimensional reconstruction in treating intractable hemifacial spasm( HFS). Methods A retrospective analysis of 40 patients with HFS who were hospitalized in Pain Department of the First Hospital of Qinhuangdao from December 2014 to December 2018 were included in this study. These patients were divided into the pulsed radiofrequency group and the nerve block group according to the different surgical methods,with 20 cases in each group. In the pulsed radiofrequency group,CT three-dimentional reconstruction was performed under pulsed radiofrequency. In the nerve block group,facial nerve block in the stylomastoid foramen area was performed by ultrasonic guidance( injected once every 5 days,3 times in total);and stellate ganglion block was performed subsequently by ultrasonic guidance( performed on the right and left side alternately once a day,10 times in total). The Cohen classification and the complete cure rate were recorded at fifteen days,three months and one year after treatment,and the complications and recurrence rate were respectively recorded at three months and one year after treatment. Results There was no significant defference in Cohen classification or complete cure rate between the two groups at fifteen days after treatment( P > 0. 05).Compared with the nerve block group,there were significantly lower Cohen classification and significantly higher cure rate in the pulsed radiofrequency group at three months and one year after treatment( P < 0. 05). There was no obvious complication in both of the two groups.Conclusion The pulsed radiofrequency guided by CT three-dimensional reconstruction is a safety and feasible therapeutic alternative for the treatment of intractable hemifacial spasm,which has the the characteristics of accurate positioning and high safety,and it has better clinical efficacy compared with that of the nerve block.

关 键 词：面神经疾病 脉冲射频 CT三维重建 面神经 星状神经节 

分 类 号：R816[医药卫生—放射医学] R745.12[医药卫生—临床医学]