创伤后三叉神经病理性疼痛48例回顾性研究

Post-traumatic trigeminal neuropathic pain:Retrospective study of 48 cases

目的:回顾48例创伤后三叉神经病理性疼痛(post-traumatic trigeminal neuropathic pain,PTTNP)患者的临床资料,总结其临床特征和治疗效果。方法:对2017年11月—2021年8月间于上海交通大学医学院附属第九人民医院口腔外科颌面神经专科诊治的48例PTTNP患者的临床资料进行总结与分析。结果:48例PTTNP患者的平均年龄为(50.3±14.2)岁,男女比例为1∶3.4。以创伤与疼痛间隔时间≤1个月者为主,占79.2%,患者平均病程为2年。常见的创伤原因包括拔除下颌磨牙、直接撞击伤及根管治疗。临床症状以持续性的中重度疼痛为主。影像学检查检出的神经损伤阳性率为16.7%。患者平均随访时间为13.1个月,疼痛缓解率超过50%的患者仅有16.7%。结论:PTTNP常见于创伤发生后的1个月内,影像学和电生理检查不能作为其特有指标;该病以药物治疗为主,预后相对较差,重度疼痛可考虑神经管减压等手术方式。

Objective:To review the clinical data of 48 patients with post-traumatic trigeminal neuropathic pain(PTTNP),and conclude its clinical manifestation and efficacy of different management.Methods:The clinical data of 48 patients with PTTNP treated in the Department of Oral Surgery and Maxillofacial Neurosurgery,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine from November 2017 to August 2021 were summarized and analyzed.Results:The average age of 48 PTTNP patients was(50.3±14.2)years while the sex ratio of male to female is 1∶3.4.Patients whose interval between traumatic nerve injuries and pain attack was mainly less than 1 month,accounting for79.2%,with an average duration of two years.The most common causes of trauma related to PTTNP include removal of mandibular molars,direct impact injuries and root canal treatment.PTTNP can be presented as moderate to severe pain persistently.The positive rate of nerve injuries detected by radiological examination was 16.7%.The average follow-up period was 13.1 months,and only 16.7%of patients had more than 50%of pain relief rate.Conclusion:Most of PTTNP happened within 1 month after injuries.However,radiological and electrophysiological examination cannot be used as specific indicators.Medication is the most applied management to PTTNP,but its long-term efficacy still remains improvement.For cases with severe pain,surgeries such as decompression of neural canal can be considered.