3D个性化导航模板辅助置入脊髓电刺激治疗亚急性期带状疱疹性神经痛患者的疗效  

3D personalized navigation template assisted spinal cord electrical stimulation for the treatment of patients with sub-acute herpetic neuralgia

作　　者：赵定亮 王然[1] 马超[1] 韩影[1] 王乃堃 王士冲 陆丽娟[1] Zhao Dingliang;Wang Ran;Ma Chao;Han Ying;Wang Naikun;Wang Shichong;Lu Lijuan(Department of Pain Medicine,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing City,Jiangsu Province 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院疼痛科,南京210008

出　　处：《中华疼痛学杂志》2020年第4期291-296,共6页Chinese Journal Of Painology

基　　金：江苏省重点研发计划(社会发展)((BE2017603)(2017675))。

摘　　要：目的评价3D个性化导航模板辅助置入脊髓电刺激治疗亚急性期带状疱疹性神经痛患者的安全性和疗效。方法收集2018年9月至2019年10月于南京大学医学院附属鼓楼医院疼痛科就诊的亚急性期带状疱疹性神经痛患者34例,年龄56~88岁,其中男23例,女11例,病程1~3个月。采用3D打印技术在病变节段下2~3个节段设计个性化导航模板并模拟规划穿刺路径,制成3D导航模板后引导Touhy针精准穿刺,并于硬膜外腔置入脊髓电刺激电极。术中测试电流完全覆盖原有疼痛区域,术后予以短时程持续刺激,刺激参数:频率40~80 Hz,脉宽210μs,自控振幅电压1~10 V,治疗7~14 d后拔出电极。记录Touhy针一次到达目标位置(患侧硬膜外后间隙中线旁)成功率及手术时间,记录治疗前及治疗后1、7、14、30、60 d简化McGill量表中感觉类疼痛分级指数(PRI-S)、情感类疼痛分级指数(PRI-A)、视觉模拟评分(VAS)、匹茨堡睡眠质量指数(PSQI)、抑郁筛查量表评分(PHQ-9)和广泛焦虑量表评分(GAD-7)。计算各随访时点50%疼痛缓解率,记录穿刺失败及神经损伤、电极断裂或脱落、感染、出血等并发症情况。结果34例患者中31例一次性穿刺到位,平均手术时间(41.5±9.5)min。各时点PRI-S、PRI-A、VAS评分比较差异均有统计学意义(F=104.50,P<0.05;F=50.54,P<0.05;F=142.50,P<0.05);术后1、7、14、30、60 d时的50%疼痛缓解率分别为58%、90%、97%、84%、74%。各时点PSQI、PHQ-9、GAD-7评分比较差异均有统计学意义(F=33.67,P<0.05;F=48.61,P<0.05;F=57.95,P<0.05)。治疗中无穿刺失败,随访期间未见明显手术并发症。结论3D个性化导航模板辅助脊髓电刺激置入是一种安全、精准的微创手术方法,可有效缓解亚急性期带状疱疹性神经痛患者的疼痛,改善生活质量。Objective To explore the safety and efficacy of spinal cord electrical stimulation(SCS)assisted by 3D personalized navigation template in the treatment of patients with sub-acute herpetic neuralgia.Methods From September 2018 to October 2019,34 patients with sub-acute herpetic neuralgia in Department of Pain Medicine,Nanjing Drum Tower Hospital,aged 56-88 years old,including 23 men and 11 women,the course of 1-3 months,were treated with SCS.3D printing technology was used to design a personalized navigation template in the next two to three segment of the lesion and simulate the planning of the puncture path.Touhy needle was precisely punctured in the guidance of the 3D personalized navigation template,and the spinal cord electrical stimulation electrode was placed in the epidural space.During the operation,the current could completely cover the original pain area,and the stimulation parameters were frequency 40-80 Hz,pulse width 210μs,automatic amplitude voltage 1-10 V.Then the electrode was pulled out after 7-14 d of the treatment.The success rate of Touhy needle reaching the target position(beside the midline of the posterior epidural space in the affected side)at one time and the total of operation time were recorded.Pain rating index-sensory(PRI-S),pain rating index-affective(PRI-A)and visual analogue scale(VAS)in simplified McGill scores,and Pittsburgh sleep quality index(PSQI),patient health questionnaire(PHQ-9)and generalized anxiety disorder-7(GAD-7)were recorded before the treatment and 1,7,14,30,60 d after the treatment,and complications,such as puncture failure,nerve injury,electrode rupture or loss,infection and bleeding were recorded in the same time.Results Thirty-one patients were punctured successfully in proper place at one time,and the average operation time was(41.5±9.5)min.There were significant differences in PRI-S,PRI-A and VAS at each time point respectively(F=104.50,P<0.05;F=50.54,P<0.05;F=142.50,P<0.05),and significant differences in PSQI,PHQ-9 and GAD-7 at each time point respectively

关 键 词：神经痛 带状疱疹后 电刺激疗法 脊髓 亚急性期 带状疱疹 

分 类 号：R752.12[医药卫生—皮肤病学与性病学]