神经导航与Hartel穿刺辅助经皮穿刺微球囊压迫术在三叉神经痛中的应用

doi:10.3760/cma.j.issn.1007-1245.2024.17.010

摘要/Abstract

摘要：

目的　探究神经导航与Hartel穿刺法辅助经皮穿刺微球囊压迫术（PMC）在三叉神经痛中的应用。方法　回顾性选取2018年1月至2020年12月西安交通大学第一附属医院收治的行PMC治疗的三叉神经痛患者82例为研究对象，根据治疗方式不同分为研究组（40例）与对照组（42例）。研究组中，男13例、女27例，年龄（60.30±7.10）岁，体重指数（21.75±3.27）kg/m²，病程（6.22±1.37）年；病侧：左肢13例，右肢27例；疼痛分支：Ⅱ型3例，Ⅲ型7例，Ⅱ+Ⅲ型24例，Ⅰ+Ⅱ型4例，Ⅰ+Ⅱ+Ⅲ型2例。对照组中，男16例、女26例，年龄（59.85±6.22）岁，体重指数（22.19±3.10）kg/m²，病程（6.50±1.19）年；病侧：左肢14例，右肢28例；疼痛分支：Ⅱ型4例，Ⅲ型8例，Ⅱ+Ⅲ型26例，Ⅰ+Ⅱ型3例，Ⅰ+Ⅱ+Ⅲ型1例。对照组采用Hartel穿刺法辅助PMC治疗，研究组采用神经导航辅助PMC治疗。比较两组穿刺情况、镇痛有效率、手术时间、住院时间、住院费用、术后并发症发生情况及手术前与术后1 d、1个月、6个月、1年、2年的疼痛视觉模拟量表（VAS）评分。采用t检验、χ²检验、重复测量方差分析及Mann-Whitney U检验。结果　两组穿刺成功率均为100%，两组穿刺次数比较差异无统计学意义（P>0.05）；研究组首次穿刺成功率为90.00%（36/40），高于对照组的71.43%（30/42），差异有统计学意义（P<0.05）。两组术后各时间点VAS评分均低于术前（均P<0.05）；研究组术后1 d的VAS评分低于对照组［（0.31±0.11）分比（0.37±0.10）分］（P<0.05）；两组术前及术后1个月、6个月、1年、2年VAS评分比较，差异均无统计学意义（均P>0.05）。对照组与研究组术后1 d、1个月、6个月、1年、2年的镇痛有效率比较，差异均无统计学意义（均P>0.05）。研究组的手术操作时间长于对照组［（36.27±4.78）min比（15.60±5.69）min］，住院费用高于对照组［（1.70±0.20）万元比（1.36±0.24）万元］，差异均有统计学意义（均（P<0.05）；两组住院时间差异无统计学意义（P>0.05）。两组术后面部麻木、皮下血肿、口唇带状疱疹、咬肌无力发生率比较，差异均无统计学意义（均P>0.05）。两组患者随访期间均未出现复视、角膜溃疡、脑梗死、脑出血、脑脊液漏等严重并发症。结论　神经导航与Hartel穿刺法辅助PMC治疗三叉神经痛的远期效果相当，神经导航辅助PMC的首次穿刺成功率高，近期效果理想，但其手术时间较长、住院费用较高，可根据临床实际选择合适手术方案。

关键词:

三叉神经痛, 神经导航, Hartel穿刺法, 经皮穿刺微球囊压迫术

Abstract:

Objective　To explore the application of neuronavigation- and Hartel puncture-assisted percutaneous microballoon compression (PMC) in patients with trigeminal neuralgia. Methods Eighty-two patients with primary trigeminal neuralgia to be treated with percutaneous balloon compression at First Hospital, Xi'an Jiaotong University from January 2018 to December 2020 were selected for the study, and were divided into a study group (40 cases) and a control group (42 cases) according to their treatment methods. There were 13 males and 27 females in the study group; they were (60.30±7.10) years old; their body mass index was (21.75±3.27) kg/m²; their disease course was (6.22±1.37) years; 13 cases had trigeminal neuralgia on their left limbs, and 27 cases their right limbs; there were 3 cases with the pain branch of type Ⅱ, 7 cases type Ⅲ, 24 cases types Ⅱ+Ⅲ, 4 cases types Ⅰ+Ⅱ, and 2 cases types Ⅰ+Ⅱ+Ⅲ. There were 16 males and 26 females in the study group; they were (59.85±6.22) years old; their body mass index was (22.19±3.10) kg/m²; their disease course was (6.50±1.19) years; 14 cases had trigeminal neuralgia on their left limbs, and 28 cases their right limbs; there were 4 cases with the pain branch of type Ⅱ, 8 cases type Ⅲ, 26 cases types Ⅱ+Ⅲ, 3 cases types Ⅰ+Ⅱ, and 1 case types Ⅰ+Ⅱ+Ⅲ. The control group took Hartel puncture-assisted PMC, and the study group neuronavigation-assisted PMC. The puncture, analgesic efficacies, operation times, hospitalization times, hospitalization costs, incidences of postoperative complications, and scores of Visual Analogue Scale (VAS) before and 1 d, 1 month, 6 months, 1 year, and 2 years after the surgery were compared between the two groups by t test, χ² test, repeated measurement analysis of variance, and Mann-Whitney U test. Results　The successful puncture rates in both groups were 100%. There was no statistical difference in the puncture times between the two groups (P>0.05). The successful puncture rate at the first time in the study group was higher than that in the control group [90.00% (36/40) vs. 71.43% (30/42)], with a statistical difference (P<0.05). The scores of VAS 1 d, 1 month, 6 months, 1 year, and 2 years after the surgery in both groups were lower than those before the surgery (all P<0.05). The score of VAS 1 d after the surgery in the study group was lower than that in the control group [(0.31±0.11) vs. (0.37±0.10); P<0.05]. There were no statistical differences in the scores of VAS 1 month, 6 months, 1 year, and 2 years after the surgery between the two groups (all P>0.05). There were no statistical differences in the analgesic efficacies 1 d, 1 month, 6 months, 1 year, and 2 years after the surgery between the two groups (all P>0.05). The operation time in the study group were longer than that in the control group [(36.27±4.78) min vs. (15.60±5.69) min; P<0.05]. The hospitalization cost in the study group was higher than that in the control group [(17 000±2 000) yuan vs. (13 600±2 400) yuan; P<0.05]. There was no statistical difference in the hospitalization time between the two groups (P>0.05). There were no statistical differences in the incidences of postoperative facial numbness, subcutaneous hematoma, herpes zoster of the mouth and lips, and biting muscle weakness between the two groups (all P>0.05). No serious complications, such as diplopia, corneal ulcer, cerebral infarction, cerebral hemorrhage, cerebrospinal fluid leakage, etc., occurred in both groups during the follow-up period. Conclusions　The long-term effects of neuronavigation- and Hartel puncture-assisted PMC for patients with trigeminal neuralgia are similar; neuronavigation-assisted PMC has a higher successful puncture rate at the first time and better short-term effect, but longer operation time and higher hospitalization cost, so the patients can choose an appropriate surgical plan according to the actual clinical situation.

Key words:

Trigeminal neuralgia, Neuronavigation, Hartel puncture, Percutaneous , microballoon compression

王小虎王瑞.

神经导航与Hartel穿刺辅助经皮穿刺微球囊压迫术在三叉神经痛中的应用 [J]. 国际医药卫生导报, 2024, 30(17): 2868-2873.

Wang Xiaohu, Wang Rui.

Percutaneous microballoon compression assisted by neuronavigation and Hartel puncture for patients with trigeminal neuralgia [J]. International Medicine and Health Guidance News, 2024, 30(17): 2868-2873.

参考文献

[1] 冯刚. 一般人群的神经病理性疼痛:流行病学研究系统回顾[J]. 中国疼痛医学杂志,2015,21(5):327-328. DOI:10.3969/j.issn.1006-9852.2015.05.002.
[2] 刘明煦,吴兰香,田胜,等. A型肉毒毒素治疗慢性偏头痛合并三叉神经痛1例[J]. 中国疼痛医学杂志,2023,29(8):636-638. DOI:10.3969/j.issn.1006-9852.2023.08.012.
[3] Araya EI, Claudino RF, Piovesan EJ, et al. Trigeminal neuralgia: basic and clinical aspects[J]. Curr Neuropharmacol, 2020,18(2):109-119. DOI: 10.2174/1570159X17666191010094350.
[4] 张潇昂,陶静怡,张达颖,等. 三叉神经痛病人疼痛灾难化风险预测模型的构建与验证[J]. 中国疼痛医学杂志,2023,29(10):741-747. DOI:10.3969/j.issn.1006-9852. 2023.10.004.
[5] Jain A. Comparative analysis of balloon compression and radiofrequency ablation in idiopathic trigeminal neuralgia: a retrospective study with a 24-month follow-up[J]. Turk J Anaesthesiol Reanim, 2019,47(2):146-150. DOI: 10.5152/TJAR.2019.53533.
[6] 李进杰,张铁军. 甲苯磺酸瑞马唑仑与丙泊酚用于深度镇静下三叉神经痛射频热凝术的比较研究[J]. 口腔医学研究,2023,39(11):973-977. DOI:10.13701/j.cnki.kqyxyj. 2023.11.007.
[7] 王然,韩影,王乃堃,等. 改良Hartel入路在卵圆孔穿刺中的应用效果[J]. 临床麻醉学杂志,2019,35(2):156-159. DOI:10.12089/jca.2019.02.013.
[8] 郑茂华,孙洪涛,雒以诚,等. 球囊压迫术治疗三叉神经痛定位技术比较及Hartel穿刺法学习曲线探讨[J]. 中华神经外科杂志,2020,36(8):829-833. DOI:10.3760/cma.j.cn112050-20200510-00281.
[9] 中华医学会神经外科学分会功能神经外科学组,中国医师协会神经外科医师,分会功能神经外科专家委员会,等. 三叉神经痛诊疗中国专家共识[J]. 中华外科杂志,2015,53(9):657-664. DOI:10.3760/cma.j.issn.0529-5815. 2015.09.005.
[10] 齐明,董吉荣,纪荣明,等. 模拟C-臂机引导下经皮穿刺球囊压迫术治疗三叉神经痛穿刺路径的应用解剖[J]. 解剖学杂志,2020,43(1):47-50. DOI:10.3969/j.issn.1001-1633. 2020.01.011.
[11] Chiarotto A, Maxwell LJ, Ostelo RW, et al. Measurement properties of Visual Analogue Scale, Numeric Rating Scale, and Pain Severity Subscale of the Brief Pain Inventory in patients with low back pain: a systematic review[J]. J Pain, 2019,20(3):245-263. DOI: 10.1016/j.jpain.2018.07.009.
[12] Asplund P, Linderoth B, Lind G, et al. One hundred eleven percutaneous balloon compressions for trigeminal neuralgia in a cohort of 66 patients with multiple sclerosis[J]. Oper Neurosurg (Hagerstown), 2019,17(5):452-459. DOI: 10.1093/ons/opy402.
[13] 莫凯,郭贤放,姚鑫,等. 术中球囊扩张容积-Meckel腔体积比值与PMC治疗原发性三叉神经痛疗效的关系[J]. 中国临床神经外科杂志,2023,28(5):311-313,317. DOI:10.13798/j.issn.1009-153X.2023.05.006.
[14] 刘永泰,朱龙,寇堃. 微球囊压迫术与微血管减压术治疗三叉神经痛的疗效对比[J]. 当代医药论丛,2024,22(9):13-15. DOI:10.3969/j.issn.2095-7629.2024.09.004.
[15] Keric N, Kalasauskas D, Kreth SL, et al. An age-dependent outcome analysis of microvascular decompression and percutaneous thermocoagulation in trigeminal neuralgia[J]. BMC Neurol, 2021,21(1):182. DOI: 10.1186/s12883-021-02197-6.
[16] 董韬,马逸,曲国辉,等. 微球囊压迫半月节治疗三叉神经痛临床疗效分析[J]. 介入放射学杂志,2020,29(2):165-168. DOI:10.3969/j.issn.1008-794X.2020.02.010.
[17] Bergenheim AT, Asplund P, Linderoth B. Percutaneous retrogasserian balloon compression for trigeminal neuralgia: review of critical technical details and outcomes[J]. World Neurosurg, 2013,79(2):359-368. DOI: 10.1016/j.wneu.2012.03.014.
[18] Filippiadis DK, Markoutsas D, Mazioti A, et al. Computed tomography-guided radiofrequency thermocoagulation of the gasserian ganglion using an alternative to Hartel anterior approach: a bicentral study[J]. Pain Physician, 2020,23(3):293-298.
[19] Elnashar A, Patel SK, Kurbanov A, et al. Comprehensive anatomy of the foramen ovale critical to percutaneous stereotactic radiofrequency rhizotomy: cadaveric study of dry skulls[J]. J Neurosurg, 2019,132(5):1414-1422. DOI: 10.3171/2019.1.JNS18899.
[20] Matys T, Ali T, Zaccagna F, et al. Ossification of the pterygoalar and pterygospinous ligaments: a computed tomography analysis of infratemporal fossa anatomical variants relevant to percutaneous trigeminal rhizotomy[J]. J Neurosurg, 2019,132(6):1942-1951. DOI: 10.3171/2019.2.JNS182709.
[21] 杨迎慧,赵姗,王雅娇,等. 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[J]. 口腔疾病防治,2023,31(8):559-566. DOI:10.12016/j.issn.2096- 1456.2023.08.004.
[22] 张源,张文进,梁阿铭. 经皮微球囊压迫术对三叉神经痛患者疼痛缓解及氧化应激指标的影响[J]. 右江医学,2023,51(1):51-55. DOI:10.3969/j.issn.1003-1383.2023.01.009.
[23] 倪兵,胡永生,卢光,等. C臂个体化确定穿刺点在半月节射频中的应用[J]. 中国微侵袭神经外科杂志,2019,24(7):310-313. DOI:10.11850/j.issn.1009-122X.2019.07.007.
[24] 董韬,马逸,曲国辉,等. 微球囊压迫半月节治疗三叉神经痛临床疗效分析[J]. 介入放射学杂志,2020,29(2):165-168. DOI:10.3969/j.issn.1008-794X.2020.02.010.