CT引导下经下颌角入路茎乳孔穿刺射频热凝对面肌痉挛的疗效分析  

Efficacy of CT-guided percutaneous stylomastoid foramen puncture through the mandibular angle approach and radiofrequency ablation of facial nerve for the treatment of hemifacial spasm

作　　者：杜鑫丹 徐露露 朱国能 赵文胜[1] 黄冰 Du Xindan;Xu Lulu;Zhu Guoneng;Zhao Wensheng;Huang Bing(Department of Pain Medicine,Zhejiang Hospital of Integrated Traditional Chinese and Western Medicine,Hangzhou 310003,China;Department of Pain Medicine,the First Hospital of Jiaxing,Jiaxing 314000,China)

机构地区：[1]浙江省中西医结合医院疼痛科,杭州310003 [2]嘉兴市第一医院疼痛科,嘉兴314000

出　　处：《中华医学杂志》2022年第33期2596-2601,共6页National Medical Journal of China

基　　金：浙江省自然科学基金(LGF20H090021);2020年杭州市农业与社会发展一般项目(20201203B173);2022浙江省医药卫生科技计划项目(2022ZH012);浙江省省市共建重点学科:疼痛医学(2019-ss-ttyx)。

摘　　要：目的探讨CT引导下经皮下颌角入路穿刺茎乳孔面神经射频热凝治疗原发性面肌痉挛的疗效。方法回顾性分析2019年1月至2021年6月在浙江省中西医结合医院疼痛科和嘉兴市第一医院疼痛科行CT引导下面神经射频热凝术治疗原发性面肌痉挛的患者共82例,其中男27例,女55例,年龄24~85(59±11)岁。根据穿刺入路的不同分为3组:乳突前入路组(A组,n=35),乳突后入路组(P组,n=25),下颌角入路组(M组,n=22)。比较3组患者术中穿刺时间、引出患侧面部肌肉抽动的最小刺激电流、射频热凝治疗终止时温度及该温度下射频热凝的时间、治疗总时间,以及术后1 d面瘫程度、并发症发生情况。结果A组、P组、M组术中穿刺时间分别为(31.0±4.9)、(31.9±6.5)、(35.3±5.9)min,差异有统计学意义(P=0.020),M组穿刺时间长于A组与P组(均P<0.05)。3组患者引出患侧面部肌肉抽动的最小刺激电流分别为(0.5±0.2)、(0.4±0.1)、(0.3±0.1)mA,差异有统计学意义(P=0.000),M组最小刺激电流小于A组与P组(均P<0.05)。3组患者射频热凝治疗终止时的温度分别为(78.6±8.1)、(76.6±8.3)、(67.0±8.4)℃,差异有统计学意义(P<0.001),M组温度小于A组与P组(均P<0.05)。3组患者终止治疗温度下射频热凝的时间、治疗总时间、术后1 d面瘫评分情况差异均无统计学意义(均P>0.05)。3组患者术后均未出现血肿、感染、听力障碍等并发症。结论CT引导下经皮穿刺茎乳孔射频热凝治疗原发性面肌痉挛有效,下颌角入路疗效更佳。Objective To investigate the efficacy of CT-guided percutaneous mandibular angle radiofrequency thermocoagulation(RFT)of facial nerve through stylomastoid foramen for the treatment of hemifacial spasm.Methods A total of 82 patients with primary facial spasm who underwent CT-guided RFT in the Department of Pain Medicine of Zhejiang Integrated Traditional Chinese and Western Medicine Hospital and Department of Pain Medicine of the First Hospital of Jiaxing from January 2019 to June 2021 were retrospectively analyzed,including 27 males and 55 females,aged 24-85(59±11)years.All patients were divided into three groups according to the different puncture approaches:anterior mastoid approach group(Group A,n=35),posterior mastoid approach group(Group P,n=25)and mandibular angle approach group(Group M,n=22).The puncture time,the minimum stimulating current inducing the twitch of facial muscles on the affected side,the temperature at the end of RFT and the duration of RFT at this temperature,the total treatment time,as well as the degree of facial paralysis and complications 1 day after operation were compared among the three groups.Results The puncture time of the Group A,Group P and Group M was(31.0±4.9)min,(31.9±6.5)min and(35.3±5.9)min,respectively,and the difference was statistically significant(P=0.020).The puncture time of the Group M was longer than that of the Group A and P(both P<0.05).The minimum stimulation current inducing the twitch of the affected facial muscle in the three groups was(0.5±0.2)mA,(0.4±0.1)mA and(0.3±0.1)mA,respectively,with a statistically significant difference(P=0.000).The minimum stimulation current in the Group M was less than that in the Group A and P(both P<0.05).The temperature at the end of RFT of the three groups was(78.6±8.1)℃,(76.6±8.3)℃ and(67.0±8.4)℃,respectively,and the difference was statistically significant(P<0.001).The temperature of the Group M was lower than that of the Group A and P(both P<0.05).There were no significant differences among the three groups

关 键 词：面神经 面肌痉挛 射频热凝 茎乳孔 CT引导 

分 类 号：R745.12[医药卫生—神经病学与精神病学]