比较神经导航与C型臂X线机引导经皮球囊压迫术治疗原发性三叉神经痛患者的疗效和安全性  

Comparison of safety and efficacy between neuronavigation guided and C-arm X-ray guided percutaneous balloon compression in the treatment of patients with primary trigeminal neuralgia

作　　者：苗兴路[1] 王增光[2] 于明圣[3] 李钊 赵长地[1] Miao Xinglu;Wang Zengguang;Yu Mingsheng;Li Zhao;Zhao Changdi(Department of Neurosurgery,Jining First People's Hospital,Jining City,Shandong Province 272000,China;Department of Neurosurgery,General Hospital of Tianjin Medical University,Tianjin City 300052,China;Department of Neurosurgery,Tianjin Huanhu Hospital,Tianjin City 300350,China)

机构地区：[1]济宁市第一人民医院神经外科,济宁市272000 [2]天津医科大学总医院神经外科,天津市300052 [3]天津市环湖医院神经外科,天津市300350

出　　处：《中华疼痛学杂志》2023年第1期44-51,共8页Chinese Journal Of Painology

基　　金：天津市重点研发计划科技支撑重点项目(20YFZCSY00010)。

摘　　要：目的比较神经导航与C型臂X线机引导经皮球囊压迫术(PBC)治疗原发性三叉神经痛(PTN)的疗效和安全性。方法回顾性分析从2019年11月21日至2021年12月30日在济宁市第一人民医院神经外科行PBC治疗PTN的患者共72例。所有患者均符合PTN诊断标准,经过正规药物治疗无效或出现药物毒副作用,临床资料和随访资料完整。根据引导方式不同,分为导航组和C臂组,每组36例。其中导航组应用神经导航引导下行PBC,C臂组应用C型臂X线机引导下行PBC。术前、术后当日和术后6个月时采用巴罗神经病学研究所(BNI)疼痛分级对两组患者进行评分,术后当日、术后6个月时对两组患者进行随访。采用SPSS 26.0对两组患者的医疗数据和随访结果进行统计分析,并对两组患者的一般资料、穿刺成功率、穿刺次数、穿刺操作时间、X线成像次数、手术疗效、穿刺相关并发症以及球囊压迫相关并发症进行比较。结果所有患者均完成随访。导航组一次性穿刺卵圆孔成功率、穿刺成功率均高于C臂组(97.2%比69.4%,χ2=10.00,P=0.002;75.0%比44.4%,χ2=6.99,P=0.008)。导航组穿刺次数、穿刺操作时间、X线成像次数均少于C臂组[1.0(0)次比2.0(2.0)次,Z=-3.23,P=0.001;12.0(1.0)min比23.5(24.0)min,Z=-3.00,P=0.003;3.0(0)次比6.0(6.0)次,Z=-3.27,P=0.002]。两组患者术后即刻有效率和术后第6个月时有效率比较差异均无统计学意义(P均>0.05)。两组患者球囊压迫相关并发症发生率差异无统计学意义(P均>0.05)。另外,C臂组出现5例(13.9%)与穿刺相关的并发症,其中面部肿胀或皮下淤血4例(11.1%),颅内感染1例(2.8%),导航组未见穿刺相关并发症。结论神经导航引导和C型臂X线机引导PBC均是有效治疗PTN的手术方法,但神经导航引导PBC能够提高手术效率和安全性。Objective To compare the efficacy and safety of neuronavigation guided and C-arm X-ray guided percutaneous balloon compression(PBC)in the treatment of primary trigeminal neuralgia(PTN).Methods Seventy-two patients underwent with PBC for PTN were retrospectively analyzed in Jining First People's Hospital,from November 21,2019 to December 30,2021,who underwent with PBC for PTN.All patients conformed to the PTN diagnostic criteria,including routine medication failure or toxic side effects,and had complete clinical and post-operative follow-up data.According to the different ways of guiding PBC,all patients were divided into navigation group and C-arm group,with 36 cases in each group.Patients were treated with neuronavigation guided PBC for PTN in the navigation group,while patients were treated with C-arm X-ray guided PBC.The Barrow Neurologic Institute(BNI)pain grading was assessed before the operation,on the operative day and at the 6th month after the operation.The medical data and follow-up results in the two groups were statistically analyzed by SPSS Statistics version 26.0.The baseline data,puncture success rate,number of puncture,puncture operation time,frequency of X-ray exposure,surgical efficacy,puncture related complications and balloon compression related complications were compared between the two groups.Results All patients were completed the follow-up.The first-attempt success rate of foramen ovale puncture and first-attempt success were higher in the navigation group than those in the C-arm group(97.2%vs.69.4%,χ2=10.00,P=0.002;75.0%vs.44.4%,χ2=6.99,P=0.008).The navigation group had less number of puncture,puncture operation time and frequency of X-ray exposure than C-arm group[1.0(0.0)time vs.2.0(2.0)times,Z=-3.23,P=0.001;12.0(1.0)min vs.23.5(24.0)min,Z=-3.00,P=0.003;3.0(0.0)times vs.6.0(6.0)times,Z=-3.27,P=0.002].There were no statistically significant differences in the immediately efficacy and the 6th month after the operation between the two groups(all P>0.05).Balloon compression-related compl

关 键 词：三叉神经痛 球囊压迫 神经导航 

分 类 号：R651.3[医药卫生—外科学]