三叉神经痛治疗中射频温度和针尖长度对射频热凝术疗效的影响

Effects of radiofrequency temperature and length of needle tip on radiofrequency thermocoagulation in treatment of trigeminal neuralgia

目的研究三叉神经痛(TN)患者行射频热凝术治疗时,射频温度和针尖长度对疗效的影响。方法回顾分析自2008年8月至2014年8月我科经射频热凝术治疗的160例TN患者临床资料,依据射频温度和针尖长度将其分为M、N、P和Q四组,每组40例。M组持续热凝温度75℃、针尖5 mm;N组热凝温度70℃、针尖5 mm;P组热凝温度75℃、针尖2 mm;Q组热凝温度70℃、针尖5 mm;四组均由CT引导经皮实施半月节穿刺射频热凝术治疗。结果四组在术后1 d、7 d、1个月和3个月各时点VAS评分与术前相比较,均明显改善(P<0.05)。M组术后各时点麻木程度评分与N组、P组和Q组相比较,均呈增高趋势(P<0.05),N组高于P组和Q组(P<0.05)。结论射频温度相同情况下,针尖暴露2 mm术后出现麻木的程度、范围及咀嚼无力情况,均低于针尖暴露5 mm。结合患者具体情况,选择合适针尖长度及合理的射频温度,将获得更为满意的临床疗效。

Objective To investigate the effects of radiofrequency （RF） temperature and length of needle tip on RF thermocoagulation in the treatment of trigeminal neuralgia （TN）. Methods A retrospective analysis was performed on the clinical data of 160 cases of TN who were admitted to our department from August 2008 to August 2014 and underwent RF thermocoagulation. According to RF temper- ature and the length of needle, the participants were equally and divided into four groups, namely M, N, P, and Q. The continued thermocoagulation temperature was 75℃, 70℃, 75℃, and 70℃ and the length of needle tip was 5 mm, 5 mm, 2 mm, and 5 mm for the M, N, P, and Q groups, respectively. The patients of the four groups all received CT-guided percutaneous RF thermocoagulation of the semilunar ganglion. Results Compared with the preoperative Visual Analog Scale （VAS） score, the 1-day, 7-day, 1-month, and 3-month postoperative VAS scores all had significant improvement for the four groups （P 〈 0.05）. At each time point, in comparison with those in the N, P, and Q groups, the numbness score of the M group showed an increasing trend （P 〈 0.05）, and the numbness scores of the N group were significantly higher than those of the P and Q groups （P 〈 0.05）. Conclusions At the same RF tempera- ture, the degree and scope of numbness and chewing weakness after operation in the group with the needle tip at 2 mm were significant- ly lower than those in the groups with the needle tip at 5 mm. It will achieve better clinical efficacy to select the appropriate length of needle tip and RF temperature with the consideration of patients＇ specific circumstance.