肌肉缩短致病原理下颈椎旁肌肉银质针松解术治疗三叉神经痛的疗效观察

Clinical evaluation of the cervical paravertebral muscles lysis with silver needle under the theory of pathogenic principle of muscle shortening on patients with primary trigeminal neuralgia

目的观察肌肉缩短致病原理下颈椎旁肌肉银质针松解治疗三叉神经痛的临床疗效及安全性。方法收集2013年1月至2017年6月遂宁市中心医院疼痛科门诊诊治的原发性三叉神经痛患者70例,性别不限,采用随机数字表法分为颈椎旁肌肉松解治疗组(A组)和神经阻滞组(B组),每组35例。A组根据解剖定位行银质针颈椎旁肌肉松解治疗,B组行三叉神经分支神经阻滞治疗。观察记录两组患者治疗前、治疗后1、3、6周及1年时的数字模拟评分(VAS)、临床疗效、不良反应发生情况。结果治疗后1、3、6周时A组VAS评分分别为[(3.4±1.2)、(2.2±1.0)及(1.2±0.7)]分;B组分别为[(1.3±1.3)、(2.1±1.4)及(2.5±1.8)]分,均较同组治疗前VAS评分显著降低,差异均有统计学意义(P均<0.01)。治疗后l、3、6周时优良率,A组分别为65.7%(23/35例)、71.4%(25/35例)、82.8%(29/35例);B组分别为80.0%(28/35例)、62.8%(22/35例)、57.1%(20/35例),且第6周时两组优良率比较差异有统计学意义(P<0.05)。治疗后1年随访时,A组复发率25.7%(9/35例);B组复发率31.4%(11/35例)。结论肌肉缩短致病原理下颈椎旁肌肉银质针松解治疗原发性三叉神经痛是一种简便、有效的方法,其短期疗效与神经阻滞相当,远期疗效优于神经阻滞。

Objective To observe the clinical efficacy and safety of the cervical paravertebral muscles lysis with silver needle under the theory of pathogenic principle of muscle shortening for patients with primary trigeminal neuralgia(PTN).Methods Seventy patients with PTN in the Pain Department of Suining Central Hospital from January 2013 to July 2017 were collected and divided into two groups:group A and group B randomly,35 cases in each.Patients were treated with cervical paravertebral muscles lysis with silver needle in group A,while patients were treated with nerve block in group B.The visual analogue scale(VAS),clinical efficacy and complications were observed at 1 week,3 weeks,6 weeks and 1 year after the treatment.Results The VAS was[(3.4±1.2),(2.2±1.0),(1.2±0.7)]scores and[(1.3±1.3),(2.1±1.4),(2.5±1.7)]scores at 1 week,3 weeks and 6 weeks after the treatment respectively,which were all decreased compared with those before the treatment(all P<0.01).The excellent and good rate was 65.7%(23/35 cases),71.4%(25/35 cases),82.8%(29/35 cases)in group A,and 80.0%(28/35 cases),62.8%(22/35 cases),57.1%(20/35 cases)in group B at 1 week,3 weeks and 6 weeks after the treatment respectively,with statistical significance(P<0.05)between group A and B at 6 weeks after treatment.The excellent and good rate was 71.4%(25/35 cases)in group A and 51.4%(18/35 cases)in group B at 1 year after treatment.The recurrence rate was 25.7%(9/35 cases)in group A,31.4%(11/35 cases)in group B.Conclusion The cervical paravertebral muscle lysis with silver needle is a simple,effective and safe method for the treatment of patients with primary trigeminal neuralgia.