超声引导联合C型臂验证下经卵圆孔选择性半月神经节射频热凝术对三叉神经痛患者治疗的可行性

The feasibility of ultrasound guidance combined with C-arm verification selective semilunar ganglion radiofrequency thermocoagulation via foramen ovale for the treatment of patients with trigeminal neuralgia

目的探讨超声引导联合C型臂验证下经卵圆孔穿刺半月神经节射频热凝术对三叉神经痛患者治疗的可行性。方法收集2019年9月至2021年6月就诊于宣武医院疼痛科确诊为三叉神经痛患者68例,性别、年龄不限,数字等级评分(NRS)≥4分。根据随机数字表1∶1分组,其中34例接受传统C型臂验证下选择性半月神经节射频热凝术治疗(C型臂验证组),34例接受超声引导联合C型臂验证下选择性半月神经节射频热凝术治疗(联合引导组)。记录两组术中穿刺至卵圆孔次数、穿刺至半月神经节靶区域次数和穿刺耗时;以及透视次数和穿刺相关并发症。术前及术后1 d、3 d、7 d、1个月、3个月NRS评分和术后并发症发生情况。结果组间比较,联合引导组术中穿刺至卵圆孔次数(2.7±1.1)次低于C型臂验证组(4.4±1.2)次,[95%CI(1.18~2.29),t=6.20,P<0.001];联合引导组术中穿刺至半月神经节靶区域次数(3.8±2.5)次低于C型臂验证组(6.7±2.6)次,[95%CI(1.65~4.12),t=4.66,P<0.001];联合引导组术中穿刺耗时(189.4±83.3)s少于C型臂验证组(301.7±91.5)s,[95%CI(69.86~154.55),t=5.29,P<0.001];联合引导组术中透视次数(3.2±1.4)次少于C型臂验证组(5.7±1.6)次,[95%CI(1.73~3.21),t=6.69,P<0.001];联合引导组面部肿胀发生率低于C型臂验证组(P<0.05)。两组术后各时点NRS评分差异无统计学意义(P均>0.05)。结论超声引导联合C型臂定位经卵圆孔穿刺半月神经节射频热凝术治疗三叉神经痛,其效率优于传统C型臂验证,且患者辐射接触量少,可安全用于临床。

Objective To explore the feasibility of ultrasound guidance combined with C-arm verification selective semilunar ganglion radiofrequency thermocoagulation via foramen ovale(FO)for the treatment of trigeminal neuralgia.Methods Sixty-eight patients diagnosed with trigeminal neuralgia between September 2019 and June 2021 in the Department of Pain Management in Xuanwu Hospital were collected,regardless of sex and age,with the numerical rating scale(NRS)≥4.The patients were divided into two groups randomly according to an allocation ratio of 1∶1.Among them,34 cases underwent selective semilunar ganglion radiofrequency thermocoagulation via foramen ovale guided by C-arm,while 34 cases underwent selective semilunar ganglion radiofrequency thermocoagulation via foramen ovale guided by ultrasound combined with C-arm.The number of FO puncture,the number and time of target area of semilunar ganglion,the number of fluoroscopy and complications involved with puncture during the operation were all record.And NRS was evaluated preoperatively,and 1 day,3 days,7 days,1 month and 3 months after the operation.Results The number of FO puncture during the operation in ultrasound-guided combined with C-arm group(2.7±1.1)times was lower than that in C-arm-guided group(4.4±1.2)times[95%CI(1.18-2.29),t=6.20,P<0.001].The number of target area of semilunar ganglion during the operation in ultrasound-guided combined with C-arm group(3.8±2.5)times was lower than that in C-arm-guided group(6.7±2.6)times[95%CI(1.65-4.12),t=4.66,P<0.001].The time of target area of semilunar ganglion puncture during the operation in ultrasound-guided combined with C-arm group(189.4±83.3)s was lower than that in C-arm-guided group(301.7±91.5)s[95%CI(69.86-154.55),t=5.29,P<0.001].The number of fluoroscopy during the operation was lower in ultrasound-guided combined with C-arm group(3.2±1.4)times than that in C-arm-guided group(5.7±1.6)times[95%CI(1.73-3.21),t=6.69,P<0.001].The incidence of facial swelling was lower in ultrasound-guided combined with C-arm group than that in C-arm-guided group(P<0.05).There was no significant difference in NRS between the two groups at all time points(all P>0.05).Conclusion Ultrasound guidance combined with C-arm verification in puncturing semilunar ganglion via FO to treat trigeminal neuralgia with radiofrequency thermocoagulation can be safely used in clinic,with more efficiency than traditional C-arm guidance and less radiation exposure to patients.