X线导引下细针穿刺圆孔射频治疗顽固性上颌神经痛的临床研究

Radiofrequency therapy of intractable maxillary neuralgia with the help of fine needle puncturing of foramen rotundum under X-ray guidance:a clinical study

目的探讨经皮穿剌圆孔射频治疗难治性上颌神经痛的可行性及有效性。方法对11例治疗失败的复发性上颌神经痛患者,在X线引导下,将头端塑形成一定弧度的射频穿刺针,以前下方入路穿刺圆孔达颅内,行上颌神经干射频温控热凝处理。以视觉模拟评分法(VAS)记录患者术前、术后72 h以及术后随访期内疼痛程度以评价疗效。结果所有患者手术一次性成功。11例患者术前VAS评分5～10分,中位评分7分。术后患者疼痛均即刻缓解,术后72 h VAS评分均为0分,平均随访时间15周,疼痛复发率为0。术后面部肿胀发生率为36.4%(4/11),无角膜溃疡与咬肌无力发生。结论经皮穿刺圆孔射频温控热凝处理上颌神经干是治疗三叉神经上颌支痛有效方法,值得进一步推广。

Objective To investigate the feasibility and efficacy of X-ray guided needle puncturing of foramen rotundum and radiofrequency therapy of intractable maxillary neuralgia.Methods Fine-needle puncturing of foramen rotundum under fluoroscopic guidance and radiofrequency ablation of maxillary nerve stem were carried out in 11 patients with intractable maxillary neuralgia who had failed to respond to other treatments.Visual analogue scale（VAS） was used to evaluate the therapeutic efficacy,and VAS score was determined before the treatment and 72 hours after the treatment.Results The procedure was successfully accomplished in all patients.Pain was relieved immediately after the treatment.VAS score before the operation was 5-10（with a median of 7）,which decreased to 0 at 72 hours after the operation.A follow-up lasting for 2 weeks to 8 months（mean of 15 weeks） was conducted.No recurrent pain occurred.Facial swelling was seen in 36.4% of cases（4/16）.Neither corneal ulcer nor masseteric weakness was seen.Conclusion Radiofrequency ablation of maxillary nerve stem with the help of fine needle puncturing of foramen rotundum under X-ray guidance is an effective treatment for intractable maxillary neuralgia.It is worthy popularizing this technique in clinical practice.