改良3D数字化导板辅助穿刺在微球囊压迫术治疗原发性三叉神经痛中的应用  

Application of improved 3D digital guide plate⁃assisted guided puncture in microballoon compression for pri⁃mary trigeminal neuralgia

作　　者：杨迎慧 赵姗 王雅娇 康楠 孟箭[2] 韩亮[3] 郑浩 YANG Yinghui;ZHAO Shan;WANG Yajiao;KANG Nan;MENG Jian;HAN Li-ang;ZHENG Hao(School of Stomatology,Bengbu Medical College,Bengbu 233030,China;Department of Stomatology,the Central Hospital of Xuzhou,Xuzhou 221000,China;Department of Medical Oncology,the Central Hosptial of Xuzhou,Xuzhou 221000,China)

机构地区：[1]蚌埠医学院口腔医学院,安徽蚌埠233030 [2]徐州市中心医院口腔科,江苏徐州221000 [3]徐州市中心医院肿瘤内科,江苏徐州221000

出　　处：《口腔疾病防治》2023年第8期559-566,共8页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：国家自然科学基金项目(81772479);国家口腔疾病临床医学研究中心临床研究项目(NCRCO-202101);徐州市科技局项目(KC21187)。

摘　　要：目的探讨改良3D打印数字化导板在微球囊压迫术(percutaneous microballoon compression,PMC)治疗原发性三叉神经痛(primary trigeminal neuralgia,PTN)的应用价值。方法纳入2019年9月至2022年1月于徐州市中心医院口腔科治疗的42例原发性三叉神经痛患者,按随机数字表法分为试验组(采取3D打印技术制作导板引导穿刺,共22例)和对照组(采取传统Hartel前入路法定位穿刺,共20例)。比较两组患者术中一次穿刺成功率、穿刺时间、手术时间及患者承受辐射量、术后并发症等,记录患者术后巴罗神经病学研究所疼痛强度表(Barrow Neurological Institute Scale,BNI)评分、面部麻木、角膜反射减退及咀嚼无力等情况。结果试验组患者在术中一次穿刺成功率(χ^(2)=21.51,P<0.001)、穿刺时间(Z=-5.51,P<0.001)、手术时间(t=9.37,P<0.001)及C形臂扫描次数(Z=-4.59,P<0.001)等方面明显优于对照组;试验组患者术后BNI评分Ⅰ级21例(95.5%)、Ⅱ级1例(4.5%),对照组患者术后BNI评分Ⅰ级17例(85.0%)、Ⅱ级2例(10.0%)、Ⅲ级1例(5.0%),差异无统计学意义(P>0.05);试验组术后出现咀嚼无力16例、结膜炎1例、唇周疱疹10例,对照组术后出现咀嚼无力18例、结膜炎2例、唇周疱疹11例、单眼失明1例,两组术后并发症差异无统计学意义(P>0.05);术后平均随访12个月,试验组和对照组均无复发。结论改良3D数字化导板引导经皮穿刺微球囊压迫术治疗原发性三叉神经痛,能在一定程度上提高穿刺的准确性和安全性,明显缩短手术时间,减少患者辐射损伤,提高手术成功率,有较高的临床应用价值。Objective To investigate the clinical efficacy and application value of an improved 3D⁃printed guide plate for the treatment of primary trigeminal neuralgia(PTN)by percutaneous microballoon compression(PMC).Meth⁃ods This prospective study included 42 patients with primary trigeminal neuralgia treated at the Department of Stoma⁃tology,Xuzhou Central Hospital,from September 2019 to January 2022.The group was divided by the random number table method into the experimental group(adopting 3D printing technology to make guide plates to guide the puncture,22 cases)and the control group(adopting the traditional Hartel anterior approach to position the puncture,20 cases).The intraoperative success rate of the first puncture,puncture time,operative time,radiation exposure of patients and postoperative complications were compared between the two groups.Postoperative Barrow Neurological Institute Scale(BNI)scores,facial numbness,diminished corneal reflexes and chewing weakness were recorded.The t⁃test,rank⁃sum test and chi⁃square test were used for statistical analysis,with P<0.05 indicating a statistically significant difference.Results The experimental group was significantly better than the control group in terms of the success rate of the first puncture(χ^(2)=21.51,P<0.001),puncture time(Z=-5.51,P<0.001),operative time(t=9.37,P<0.001),and the number of C⁃arm scans(Z=-4.59,P<0.001).Postoperative BNI scores of the experimental group included 21 cases of gradeⅠ(91.5%)and 1 case of gradeⅡ,while the control group included 17 cases of gradeⅠ(85.0%),2 cases of gradeⅡ(10.0%)and 1 case of gradeⅢ(5.0%),with no statistical significance(P>0.05).In the experimental group,16 patients had postoperative masseter weakness,1 had keratitis and 10 had perilabial herpes,while in the control group,18 patients had postoperative masseter weakness,2 had keratitis,11 had perilabial herpes and 1 had monocular blindness.There was no significant difference in postoperative complications between the two groups(P>0.05).At 12 m

关 键 词：3D打印技术 数字化 导板 原发性三叉神经痛 微球囊压迫术 精准定位 穿刺 卵圆孔 面部麻木 失明 

分 类 号：R78[医药卫生—口腔医学]