颧下眶下连线在圆孔前入路穿刺治疗三叉神经痛中的临床应用

Clinical application of the subzygomatic and suborbital connecting line in anterior approach of foramen rotundum puncture

目的探讨颧下眶下连线在圆孔前入路穿刺治疗三叉神经痛中的临床应用价值。方法南通市第一人民医院2017年1月—2018年12月收治的原发性三叉神经痛患者24例,随机分为2组,A组:术前于面部标记颧下眶下连线,按照标记的参考线穿刺,先进入翼腭窝靠近圆孔,再调整方向进入圆孔。B组:面部没有参考线,穿刺沿着上颌骨后外侧壁滑入翼腭窝,X线下逐步调整方向,进入圆孔。分析比较两组的术前疼痛目测类比评分(visual analogue scale,VAS)、手术时间、穿刺次数、首次准确率、术中穿刺并发症和术后有效率,以及术后上唇、腭部麻木率。评价A组患者颧下眶下连线作为参考线与穿刺针方向是否一致。结果本组24例患者均完成前入路圆孔穿刺,无重大并发症。两组患者的术后有效率、上唇、腭部麻木率均达到了100%。B组患者中有6例患者出现面部血肿,A组无面部血肿者。两组手术时间、穿刺次数、首次准确率比较,差异均有统计学意义(均P<0.05)。A组患者的颧下眶下连线与穿刺针方向基本一致,平均角度为(0.63±2.82)°。结论经圆孔穿刺射频治疗三叉神经痛是有效、可行的。圆孔前入路穿刺中颧下眶下连线给术者有很好的参考价值;可明显减少并发症,减少手术时间及穿刺次数,提高准确率,值得临床推广。

Objective To explore the reference value in anterior approach penetrate foramen rotundum with the subzygomatic and suborbital connecting line.Methods 24 patients with primary trigeminal neuralgia were admitted in The First People's Hospital of Nantong from January 2017 to December 2018,who were randomly divided into two groups.Group A:The subzygomatic and suborbital connecting line was marked on the face before operation and punctured according to the marked reference line.The pterygopalatine fossa was punctured first,then the direction was adjusted to enter the foramen rotundum.Group B:There was no facial reference line.The puncture needle slided into the pterygopalatine fossa along the posterior lateral wall of the maxilla.The direction of puncture was gradually adjusted with the X-ray photography and into the foramen rotundum.Preoperative pain score(VAS),operation time,puncture times,intraoperative puncture complications,first attempt accuracy rate,effective rate and numbness rate of upper lip and palate in postoperation of the two groups were analyzed.Meanwhile,the reference line was evaluated if it was consistent with between the subzygomatic suborbital line and the direction of puncture needle in group A.Results All 24 patients completed to puncture the foramen rotundum through the anterior approach without major complications.The effective rate of the postoperative and the numbness rate of postoperative upper lip and palate were 100%of two groups.There were 6 cases with facial hematoma in B group.Compared operation time,puncture times,first attempt accuracy rate,there were significant statistical differences(P<0.05).The line between subzygomatic and suborbital was consistent with the direction of puncture needle,the average angle was(0.63±2.82)°.Conclusion It is feasible of puncturing foramen rotundum to treat trigeminal neuralgia,between subzygomatic and suborbital connecting line is of good reference value for the operation through the anterior approach,which can reduce complications,operation time,puncture times and be worthy of promotion.