半月神经节射频热凝术中针尖裸露长度和射频温度对三叉神经痛疗效及并发症的影响

关键词：半月神经节  射频热凝  针尖裸露端长度  三叉神经痛

Keywords:semilunar ganglion  radiofrequency thermocoagulation  exposed length of needle tip  trigeminal neuralgia

摘要：

      摘要 目的：探讨不同针尖长度的穿刺套管针及不同射频温度对于半月神经节射频热凝术的三叉神经痛缓解、术后复发及面部麻木等并发症的关系。 方法：80例原发性三叉神经痛的患者，随机分为四组，均在CT引导下经皮行穿刺半月节射频热凝手术，A组应用穿刺套管针针尖裸露端长为5mm的射频针进行治疗，持续热凝温度为75℃;B组针尖裸露端5mm,温度为70℃;C组针尖裸露端2mm，温度为75℃;D组针尖裸露端2mm，温度为70℃。射频热凝的时间均为120s，2次。术后24h、3d、7d、1m、3m随访观察4组间疼痛强度（VAS评分），生存质量评分（QOL），麻木范围及程度，以及咀嚼无力、角膜炎等并发症的发生率等有无显著差异。 结果：80例患者全部随访成功。4组患者术后3个月的VAS及QOL评分均较术前有明显的改善(P<0.05),且各组间差异无显著性(P>0.05)。术后所有患者均出现不同程度的面部麻木感(发生率100％)，麻木程度评分随术后时间的延长逐渐降低，术后1个月及3个月时，A组麻木程度评分均明显高于B、C、D组，B组高于C、D组，C组的麻木程度评分也显著高于D组（P<0.05）。术后3m， A组的麻木范围和咀嚼无力发生率显著高于C、D两组（P<0.05），B组显著高于D组。 结论：CT引导下半月节射频术治疗原发性三叉神经痛，是一种安全有效的治疗方法；在相同的射频温度下，应用针尖裸露端为2mm的穿刺套管针进行射频治疗，术后所产生的麻木范围、麻木程度以咀嚼无力明显少于针尖裸露端为5mm的穿刺套管针；应用相同穿刺套管针，75℃射频热凝，术后麻木程度评分明显高于70℃组。

Abstract:

      Abstract Objective: To explore effects of the exposed length of active needle tip and temperature in semilunar ganglion radiofrequency thermocoagulation on trigeminal neuralgia patient's pain relief, recurrence and facial numbness. Method: Eighty patients with primary trigeminal neuralgia ongoing semilunar ganglion radiofrequency thermocoagulation were randomly allocated into 4 groups：Group A （the exposed length of needle tip was 5mm, and the temperature was 75℃）; Group B （the exposed length of needle tip was 5mm, and the temperature was 70℃）; Group C （the exposed length of needle tip was 2mm, and the temperature was 75℃）; D group （the exposed length of needle tip was 2mm, and the temperature was 70℃）. The duration of radiofrequency was 120 s, 2 times. Visual analogue scale（VAS）, quality of life（QOL）, the severity and range of facial numbness, inability to chew,keratitis and other complications were recorded at 24h，3d，7d.1month，3month after the procedure. Result: All the 80 patients were completed follow-up for 3 months. The scores of VAS and QOL of all patients decreased significantly (P<0.05) than baseline level. There was no significant difference among four groups. After 3 month of procedure, all patients felt facial numbness(100%), and the scores of numbness reduced gradually with the time; 1month and 3month after procedure, score of facial numbness in Group A was higher than that of the other three groups, that in Group B was higher than that in Group C and Group D,that in Group C was higher than that in Group D（P<0.05）; 3 month after procedure, the severity of facil numbness and the incidence of unable to chew in Group A were higher than those in Group C and Group D, those in Group B was higher than those in Group D（P<0.05）. Conclusion: Semilunar ganglion radiofrequency thermocoagulation under CT guidance for the treatment of primary trigeminal neuralgia was a safe and effective method.The radiofrequency needle with 2mm exposed length was as effective as the needle with 5mm exposed length under the same radiofrequency temperature in leading to less facial numbness and less incidence of unable to chew.. Radiofrequency by 70℃ could result in less numbness than by 75℃ with the same exposed length of needle.