C臂引导下结合电刺激定位应用于三叉神经半月节射频热凝治疗原发性上颌神经痛的效果

摘要

目的 探讨C臂引导下结合电刺激定位应用于三叉神经半月节射频热凝治疗原发性上颌神经痛的效果.方法 选取2012年1月～2015年12月于徐州医科大学附属淮安医院接受治疗的原发性三叉神经痛第Ⅱ支(上颌神经)患者50例,采用随机数字表法分为观察组和对照组,各25例.患者均在C臂引导下应用改良的Hartel前入路法经卵圆孔L穿刺进入三叉神经半月节,对照组单纯在C臂引导下定位行射频热凝毁损,观察组在术中联合电刺激定位,再行射频热凝毁损.记录术前、术后即刻、术后1个月、术后3个月、术后6个月和术后12个月的疼痛视觉模拟评分(VAS)、有效率、复发率及并发症情况.结果 所有患者均完成随访.观察组术后即刻、术后1、3、6、12个月疼痛VAS明显低于对照组,差异有统计学意义(P＜0.05).观察组术后各时段有效率均高于对照组,复发率均低于对照组,差异有统计学意义(P＜0.05).观察组合并患侧Ⅲ支支配区域麻木发生率明显低于对照组,差异有统计学意义(P＜0.05).两组术后并发症发生率差异无统计学意义(P＞0.05).结论 与单纯C臂引导下定位对比,术中联合电刺激定位准确率较高,临床疗效较好,复发率低.%Objective To explore the effect of application of C-arm guidance combined with electrical stimulation in trigeminal neuronal radiofrequency coagulation therapy for primary maxillary neuralgia.Methods 50 cases of patients with primary trigeminal maxillary neuralgia of the Ⅱ branch treated in the Affiliated Huai'an Hospital of Xuzhou Medical University from January 2012 to December 2015 were selected,and randomly divided into the observation group and the control group,each group had 25 cases.All patients were treated by C-arm guided modified Hartel approach through foramen ovale into the trigeminal ganglion.The control group was treated with radiofrequency coagulation guided by C-arm,the observation group was combined with electrical stimulation directing.The visual analogue scale (VAS),excellent rate,recurrence rate and complications of the two groups were follow-up in preoperative and postoperative instantly,1 month,3 months,6 months and 12 months after operation.Results Both the control group and the observation group were followed up completely.The VAS scores of postoperative instantly,1 month,3 months,6 months and 12 months after operation in the observation group were obviously lower than those of the control group,and the differences were statistically significant (P ＜ 0.05).The excellent rates of the observation group were higher and the recurrence rates were lower than those of the control groups,with statistically significant differences (P ＜ 0.05).The incidence of numbness in mandibular nerve zone of Ⅲ branch was lower in the observation group than that in the control group,with statistically significant difference (P ＜ 0.05).There was no significant difference in complicafions between the two groups (P ＞ 0.05).Conclusion Compared with C-arm guidance,combined with electrical stimulation has higher location accuracy,better clinical effects and lower recurrence rate.