神经导航下球囊压迫术与射频热凝治疗三叉神经痛的临床效果及复发情况比较

Comparison of Clinical Effect and Recurrence of Trigeminal Neuralgia Treated by Balloon Compression and Radiofrequency Thermocoagulation under Neuronavigation

目的比较神经导航下球囊压迫术与射频热凝治疗三叉神经痛的临床效果及复发情况。方法选取2017年5月至2020年5月河北北方学院附属第一医院收治的97例三叉神经痛患者,根据手术方式不同分为对照组(采用神经导航下球囊压迫术治疗,48例)和研究组(采用神经导航下射频热凝治疗,49例)。比较两组术前、术后1 d、7 d及1个月的疼痛程度、睡眠质量,临床疗效、患者生活质量及并发症发生率、复发率。结果手术前后疼痛视觉模拟评分法(VAS)、匹兹堡睡眠质量指数(PSQI)、健康调查简表(SF-36)各维度评分的主效应差异有统计学意义(P<0.01);不考虑测量时间,两组间VAS评分、PSQI、SF-36各维度评分的主效应差异有统计学意义(P<0.01);VAS评分、PSQI、SF-36各维度评分的时点间与组间存在交互作用(P<0.01)。两组术后1 d、7 d、1个月VAS评分、PSQI均低于术前,SF-36各维度评分均高于术前(P<0.05),且研究组术后1 d、7 d、术后1个月VAS评分、PSQI均低于对照组,研究组SF-36各维度评分均高于对照组(P<0.05)。两组治疗总有效率比较差异无统计学意义(P>0.05)。术后6个月,研究组咀嚼肌肌力下降发生率低于对照组[16.33%(8/49)比45.83%(22/48)](χ^(2)=9.882,P=0.002)。研究组复发率低于对照组[2.04%(1/49)比16.67%(8/48)](χ^(2)=4.574,P=0.033)。结论神经导航下球囊压迫术与射频热凝术治疗三叉神经痛的临床疗效相当,但射频热凝术治疗后患者疼痛程度更低,睡眠质量及生活质量更高,且复发率更低。

Objective To explore the clinical effect and recurrence of balloon compression and radiofrequency thermocoagulation under neuronavigation in the treatment of trigeminal neuralgia.Methods A total of 97 patients with trigeminal neuralgia admitted to the First Affiliated Hospital of Hebei Northern University from May 2017 to May 2020 were included and divided into a control group(treated with balloon compression under neuronavigation,48 cases)and a study group(treated with radiofrequency thermocoagulation under neuronavigation,49 cases).The pain level,sleep quality,clinical efficacy,postoperative complications,recurrence rate and quality of life were compared between the two groups before operation,and 1 d,7 d and 1 month after operation.Results The main effects of visual analogue scale(VAS),Pittsburgh sleep quality index(PSQI)and the MOS item short from health survey(SF-36)scores before and after surgery were significantly different(P<0.01).Regardless of the measurement time,there were significant differences in the main effects of VAS score,PSQI and SF-36 dimension scores between the two groups(P<0.01).There were interactions in VAS score,PSQI,and SF-36 scores between time points and groups(P<0.01).The VAS scores and PSQI of the two groups at 1 d,7 d and 1 month after operation were lower than those before operation,and the scores of SF-36 in each dimension were higher than those before operation(P<0.05);at 1 d,7 d,1 month after operation,the VAS score and PSQI of the study group were lower than those in the control group,and the SF-36 of each dimension in the study group were higher than those in the control group(P<0.05).There was no significant difference in the total effective rate between the two groups(P>0.05).Six months after operation,the incidence of masticatory muscle strength decline in the study group was lower than that in the control group[16.33%(8/49)vs 45.83%(22/48)](χ^(2)=9.882,P=0.002).The recurrence rate of the study group was lower than that of the control group[2.04%(1/49)vs 16.67%(8/48)](χ^(2)=4.574,P=0.033).Conclusion Balloon compression and radiofrequency thermocoagulation under neuronavigation have the same clinical efficacy in the treatment of trigeminal neuralgia,but radiofrequency thermocoagulation has lower postoperative pain,higher sleep quality and life quality,and lower recurrence rate.