X线下2种穿刺方法射频热凝治疗上颌神经痛的疗效分析

Curative effect analysis of the radiofrequency thermocoagulation for treating maxillary nerve neuralgia by two percutaneous puncture methods under X-ray

目的研究X线下经皮穿刺卵圆孔和圆孔射频治疗上颌神经痛临床疗效对比。方法对2008—2015年收治住院的69例单纯上颌神经痛患者随机分为2组。A组:33例,穿刺卵圆孔,患者采用Hartel前入路法,根据射频针尖至耳-床线的垂直距离确定入颅深度后,行射频热凝。B组:36例,穿刺圆孔,采用弯针穿刺进入翼腭窝,局部注射2%利多卡因1 m L,X线定位圆孔穿刺方向,再穿入圆孔,X线下定位确定进入圆孔后行射频治疗。结果所有患者均顺利完成手术,穿刺针均准确位于圆孔内和卵圆孔内,治疗后疼痛即刻缓解,无严重并发症发生,眶下区及上腭均有感觉迟钝。所有患者随访6个月~2年,两组3天有效率、术后复发率差异比较无统计学意义(P>0.05)。两组在非患支神经损伤的发生率差异显著(P<0.05)。手术时间A组平均48.79 min,B组平均50.32 min;术中疼痛评分A组平均7.48分,B组平均2.92分;术中患者满意度评分A组平均2.64分,B组平均5.36分。两组在手术时间无统计学差异,在术中疼痛评分及患者满意度评分具有统计学差异。结论经翼腭窝穿刺圆孔治疗上颌神经疼痛具有一定的优势,值得推广。

Objective To observe the clinical effects of percutaneous puncturing of foramen rotundum（FR） and foramen oval （FO） for radiofrequency thermocoagulation to treat primary maxillary nerve neuralgia under X-ray. Methods 69 cases of simple maxillary neuralgia patients were divided into two groups at random, which were hospitalized in our hospital from 2008 to 2015. Group A： 33 ca- ses were punctured into FO by Hartel＇s way, measuring the cranial depth- the vertical distance line between the needlepoint and ear-bed line, then conducted radiofrequency thermocoagulation. Group B： 36 cases were punctured into FR, at first punctured into pterygopala- tine fossa （PPF）with curved needle, injected 2% lidocaine 1 mL, using X-ray to locate the direction, then pierced into FR, under X- ray the needle was comfirmed in the FR before radiofrequency thermocoagulation. Results All patients were successfully completed surgery, the needles were accurate in the FR and FO, pain was relieved after treatment immediately, and no serious complications oc- curred, infraorbital region and palate were insensitive. All patients were followed up for 6 months to 2 years. The rate of three-day effi- ciency of two groups and postoperative recurrence rate difference were not significant （P〉 0.05）. A significant difference of two groups was found in the incidence of nerve injury （P〈 0.05）. Group A ：Operation average time was 48.79 minutes; group B： Operation aver- age time was 50.32 minutes.Intraoperative pain score： group A： the average was 7.48 points; Group B： the average was 2.92 points. Intraoperative patient satisfaction scores, group A： the average 2.64 points;Group B： the average 5.36 points. No statistical differences were found in operation time, intraoperative pain score and patient satisfaction score had differences statistically between the two groups patients. Conclusion It is worth promoting the treatment of maxillary nerve neuralgia with piercing FR by PPF because of its certain advantages.