卵圆孔大小对经皮穿刺球囊压迫术后疼痛复发的预测价值  

Predictive value of foramen ovale size on pain recurrence after percutaneous balloon compression

作　　者：李传胜 杨婕[2] 韩凤伟[1] 呼铁民[1] 张继伟[1] 刘兵 闫丽娜[1] 刘文霞 王昆鹏[1] LI Chuansheng;YANG Jie;HAN Fengwei;HU Tiemin;ZHANG Jiwei;LIU Bing;YAN Lina;LIU Wenxia;WANG Kunpeng(Department of Neurosurgery,Affiliated Hospital of Chengde Medical College,Chengde Hebei 067000;Department of Nutrition,Affiliated Hospital of Chengde Medical College,Chengde Hebei 067000,China)

机构地区：[1]承德医学院附属医院神经外科,河北承德067000 [2]承德医学院附属医院营养科,河北承德067000

出　　处：《中南大学学报（医学版）》2023年第5期682-690,共9页Journal of Central South University ：Medical Science

基　　金：河北省医学科学研究课题计划(20210969)。

摘　　要：目的:原发性三叉神经痛(primary trigeminal neuralgia,PTN)是神经外科常见的颅神经疾病,严重危害患者的身心健康。经皮穿刺球囊压迫术(percutaneous balloon compression,PBC)通过微创穿刺阻断痛觉传导,已成为治疗PTN的有效术式。然而,PBC术后面部疼痛复发仍是困扰PTN患者的一大问题。术中球囊的形状、压力及压迫时间等因素可影响PBC术后患者的预后。卵圆孔大小对Meckel’s腔内的球囊压力有影响。本研究旨在通过分析卵圆孔大小与PBC术后疼痛复发之间的联系,探讨其对PBC术后疼痛复发的预测价值。方法:回顾性分析2018年11月至2021年12月于承德医学院附属医院神经外科就诊行PBC治疗的60例PTN患者的临床资料,随访并记录患者术后1、3、6及12个月的巴罗神经学研究所(Barrow Neurological Institute,BNI)疼痛评分,根据术后第12个月时的BNI疼痛评分分级将患者分为治愈组(BNI疼痛评分分级I~Ⅱ级)和复发组(BNI疼痛评分分级Ⅲ~Ⅴ级),测量2组患者患侧及健侧的卵圆孔长径、横径、面积数据。采用受试者操作特征(receiver operating characteristic,ROC)曲线及曲线下面积(area under the curve,AUC)分析2组患者患侧卵圆孔长径、横径、面积及患/健侧卵圆孔长径比、横径比、面积比与PBC术后疼痛复发之间的关系。结果:截止术后随访第12个月,50例(83.3%)患者疼痛缓解(治愈组),10例(16.7%)患者存在不同程度的疼痛复发(复发组),总有效率83.3%。2组患者术前基线资料的差异均无统计学意义(均P>0.05)。治愈组患侧卵圆孔长径、患/健侧卵圆孔长径比及面积比均明显大于复发组(均P<0.05);2组间患侧卵圆孔横径、面积及患/健侧卵圆孔横径比的差异均无统计学意义(均P>0.05)。ROC曲线分析结果显示:患侧卵圆孔长径的AUC为0.290(95%CI 0.131~0.449,P=0.073),患/健侧卵圆孔长径比的AUC为0.792(95%CI 0.628~0.956,P=0.004),患/健侧卵圆孔面积比的AUC为Objective:Primary trigeminal neuralgia(PTN)is a common cranial nerve disease in neurosurgery,which seriously endangers the physical and mental health of patients.Percutaneous balloon compression(PBC)has become an effective procedure for the treatment of PTN by blocking pain conduction through minimally invasive puncture.However,the recurrence of facial pain after PBC is still a major problem for PTN patients.Intraoperative balloon shape,pressure and compression time can affect the prognosis of patients with PBC after surgery.The foramen ovale size has an effect on the balloon pressure in Meckel’s lumen.This study aims to analyse the predictive value of foramen ovale size for postoperative pain recurrence of PBC by exploring the relationship between foramen ovale size and postoperative pain recurrence of PBC.Methods:A retrospectively analysis was conducted on the clinical data of 60 patients with PTN who were treated with PBC in Department of Neurosurgery,Affiliated Hospital of Chengde Medical College from November 2018 to December 2021.We followed-up and recorded the Barrow Neurological Institute(BNI)pain score at 1,3,6 and 12 months after operation.According to the BNI pain score at 12 months after surgery,the patients were divided into a cure group(BNI pain score I toⅡ)and a recurrence group(BNI pain scoreⅢtoⅤ).The long diameter,transverse diameter and area of foramen ovale on the affected side and the healthy side of the 2 groups were measured.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used for analysis the relationship between the recurrence of pain and the long diameter,transverse diameter,area of foramen ovale on the affected side,and aspect ratio,transverse diameter ratio,area ratio of foramen ovale on the affected side to healthy side in the 2 groups.Results:At the end of 12 months of follow-up,50(83.3%)patients had pain relief(the cured group),10(16.7%)patients had different degrees of pain recurrence(the recurrence group),and the total effective rate was 83.3%.

关 键 词：原发性三叉神经痛 经皮穿刺球囊压迫术 卵圆孔 疼痛复发 预测 

分 类 号：R651.3[医药卫生—外科学]