甘油注射半月节后根阻滞治疗三叉神经痛

Percutaneous retrogasserian glycerol rhizolysis for trigeminal neuralgia

目的:探讨经皮甘油注射阻滞治疗三叉神经痛的干预效果及相关影响因素。方法:选择2001-01/2002-12第三军医大学大坪医院收治的三叉神经痛患者210例,均自愿参加本观察。常规解释操作过程及可能反应,术前30min口服安定。患者取仰卧,采用Hakanson前入路穿刺法,行经皮穿刺半月节后根甘油注射阻滞术。穿过卵圆孔后再进入1.0～1.5cm。注入普鲁卡因进行阻滞区测试,当针刺检查面部相应区域时痛觉完全消失,证实针尖位置合适,注入无水甘油0.4～0.5mL。以疼痛完全缓解为显效;疼痛未完全缓解为无效。以第1次注射时疼痛是否完全缓解作为因变量,选取可能的影响因素年龄、病史长短、有无明确的扳机点、疼痛持续时间、疼痛发作次数、单支还是多支、既往有无外科治疗、甘油注射量、有无脑脊液流出、普鲁卡因测试是否完全无痛、甘油注射时的体位等作为自变量。应用Logistic回归程序对治疗效果及影响因素进行回顾性分析。结果:210例患者全部进入结果分析。67例行2次注射,16例注射3次,治疗后疼痛完全缓解率为92.4%。有无扳机点和普鲁卡因测试是否完全不痛为影响干预效果的影响因素,Logistic回归分析OR>10,P<0.01。结论:经皮甘油注射阻滞术治疗三叉神经痛能显著改善患者的疼痛。为提高三叉神经痛患者的干预成功率。

AIM:To investigate the interventional effects and influencing factors of percutaneous retrogasserian glycerol rhizolysis(PRGR) for trigeminal neuralgia.METHODS:Totally 210 patients with trigeminal neuralgia hospitalized in Daping Hospital of Third Military Medical University between January 2001 and December 2002 were all voluntary to attend the observation.The procedures and possible reaction were routinely explained to the patients,and then they orally took ansiolin 30 minutes before operation.PRGR was performed by Hakanson's anterior acupuncture when the patients lied on the back.The acupuncture was deepened into 1 to 1.5 cm through oval foramen.The blocked area was detected by injecting procaine.Pain disappeared completed in the corresponding area of acupunctured facial part,which verified that the position of needle's tip was proper.Then,0.4 to 0.5 mL anhydrous glycerol was injected.The complete relief of pain was effective and incomplete relief was ineffective.Whether the first injection could relieve pain completely was regarded as the dependent variable,and the possible influencing factors including age,history,trigger zone,duration of pain,times of pain,single or multiple nerves,surgical treatment,injection doses of glycerin,diffluence of cerebrospinal fluid,pain relieve in the detection of procaine,posture when injection were regarded as the independent variables.The therapeutic effect and influencing factors were studied retrospectively using logistic regression analysis.RESULTS:All the 210 patients with trigeminal neuralgia were involved in the result analysis.Sixty seven underwent two procedures,16 underwent three.Complete pain relief achieved in 92.4% patients.The presence of a distinct trigger zone and painlessness tested by procaine were both strong indicators of complete relief.The value of OR exceeded 10 by logistic regression analysis and P was less than 0.01.CONCLUSION:PRGR for trigeminal neuralgia can relieve patients' pain obviously.To increase the successful rate of intervention and to improve the pain relief in the trigeminal neuralgia patients,the cases selected for study should have distinct trigger zone,and be painless in the procaine detection,therefore avoiding re injection.