椎动脉优势、基底动脉弯曲与经典三叉神经痛的相关性研究

Research of the relationship among the vertebral artery dominance,basilar artery curvature and diopathic trigeminal neuralgia

目的探讨经典三叉神经痛(CTN)与椎动脉优势(VAD)的之间的关系。方法收集384例CTN患者和384例非三叉神经痛(N-CTN)患者的临床资料,并根据Frighetto的标准评价CTN患者的症状评分;测量两侧椎动脉直径以及基底动脉弯曲长度(BL),分析CTN与VAD的发生率、疼痛程度及发生侧别的关系。结果 VAD的发生率在CTN组(61.46%)和N-CTN组(49.74%)比较具有统计学差异(P<0.05);CTN组右侧疼痛的发生率高于左侧,VAD左侧优势的比率在CTN组和N-CTN组中均明显高于右侧;CTN组VAD亚组基底动脉弯曲的发生率为75.42%,BL长度为(3.72±1.47)mm,N-CTN组VAD亚组为59.68%、(2.39±1.08)mm,两组比较差异均具有统计学意义(均P<0.05)。427例VAD患者中,基底动脉弯曲292例,基底动脉弯曲方向发生在优势侧对侧共计246例,占84.25%。在不同级别椎动脉直径差异中,CTN患者症状评分各组间比较差异具有统计学意义(均P<0.05);在不同级别基底动脉弯曲中,CTN患者症状评分各组间比较差异具有统计学意义(均P<0.05)。CTN评分与椎动脉直径差异呈正相关(r=0.341,P=0.001),与BL呈正相关(r=0.134,P=0.001)。结论 CTN患者VAD发生率较N-CTN人群高,其疼痛侧别多见于VAD对侧;VAD直径差异越大,基底动脉弯曲程度越大,CTN患者症状评分越高。

Objective To investigate the relationship between classical trigeminal neuralgia（ CTN） and vertebral artery dominance（ VAD）. Methods The clinical data of CTN patients（ n = 384） and None-CTN（ NCTN） patients（ n = 384） were collected; and the score of CTN patients ＇ symptom was evaluated by Frighetto standard,the diameter of bilateral vertebral artery and the bending length of basilar artery（ BL） were measured; and record the incidence,pain degree and the side difference of VAD and CTN were analyzed. Results The incidence of VAD was significantly different between CTN（ 61. 46%） and N-CTN group（ 49. 74%）（ P 0. 05）. In CTN group,the incidence of right pain was significantly higher than that of the left side（ P 0. 05）. The ratio of left dominance in CTN group and N-CTN group were significantly higher than right. VAD is often find in left side（ P 0. 05）; in the patients of VAD,the incidence of basilar artery curvature was 75. 42%,BL was about（ 3. 72 ± 1. 47） mm in CTN group,however,in N-CTN group,the incidence of basilar artery curvature is 59. 68%,BL was about（ 2. 39 ± 1.08） mm,which was statistical difference between the two groups（ P 0. 05）. There were 292 cases in the 427 VAD patients which the basilar artery was tortuous,there were 246 cases which the basilar artery curved in the contralateral side of the dominant,accounting for 84. 25%. The symptom score of CTN patients had significantly different during the difference level of bilateral vertebral artery; and the symptom score of CTN patients also had significantly different during difference level of basilar artery curvature. There was a positive correlation between CTN scores and vertebral artery diameter（ r = 0. 341,P = 0. 001） in CTN patients,which was positively correlated with BL（ r = 0. 134,P =0. 001）. Conclusions The incidence of VAD is higher in CTN group than that in N-CTN group,and the pain occured more often in the contralateral side of VAD. The greater the difference of VAD diameter is,the greater the degree of basilar artery curvature is,and the higher the score of CTN patients is.