枕大神经微创减压术治疗枕大神经源性顽固性偏头痛的效果分析

Therapeutic effect of great occipital nerve decompression on great occipital neurogenic intractable migraine

目的探讨枕大神经微创减压术治疗枕大神经源性顽固性偏头痛的有效性、安全性。方法选择西南医科大学附属成都三六三医院神经外科自2018年12月至2019年12月收治的51例顽固性偏头痛患者进行研究,所有患者均经枕大神经阻滞试验确定为枕大神经源性,均行枕大神经微创减压术治疗,并评定患者术后末次随访时预后等级及比较患者手术前后疼痛严重程度、疼痛发作频率的差异。结果51例患者术后随访(12.02±3.36)个月,末次随访时10例患者治愈,31例患者显效,6例患者好转,2例患者效差,2例患者无效,总有效率为80.40%(41/51);疼痛视觉模拟评分由术前(7.47±0.76)分降至(1.75±1.91)分,疼痛发作频率由术前(9.00±1.74)次/月降至(2.82±2.47)次/月,差异均有统计学意义(P<0.05)。术后7例患者自述手术部位感觉麻木,但其中6例于术后3个月左右好转,只有1例患者自述麻木感持续。结论对于枕大神经源性顽固性偏头痛,枕大神经微创减压术是一种有效且安全的治疗方式。

Objective To study the effectiveness and safety of great occipital nerve decompression in great occipital neurogenic intractable migraine.Methods Fifty-one patients with great occipital neurogenic intractable migraine admitted to our hospital from December 2018 to December 2019 were chosen in our study.All patients were confirmed to be of great occipital neurogenic intractable migraine by blocked test and all patients underwent minimally invasive decompression of great occipital nerve.Preoperative and postoperative questionnaires were used to compare the severity of pain and frequency of pain episodes,and the prognoses of these patients were evaluated at the last follow-up.Results Fifty-one patients were followed up for(12.02±3.36)months after surgery;at last follow-up,10 patients were cured,31 patients had obvious effect,6 patients got improvement,2 patients had poor effect,and 2 patients had no effect,with total effective rate of 80.40%(41/51).There were significant differences between before surgery and after surgery in the pain visual analog scale scores(7.47±0.76 vs.1.75±1.91)and frequency of pain episodes([9.00±1.74]times/month vs.[2.82±2.47]times/month,P<0.05).Seven patients had temporary numbness at the surgical site after surgery,but 6 patients improved about 3 months after surgery and only one patient had persistent numbness.Conclusion Great occipital nerve decompression is an effective and safe treatment method for great occipital neurogenic intractable migraine.