头面部带状疱疹后神经痛微创疗法的非随机对照研究

Minimally invasive treatment of postherpetic neuralgia in head and face:a non-randomized controlled study

目的:比较鞘内注射、神经干三氧水注射、半月神经节三氧水注射、C形臂引导下半月神经节高电压脉冲射频(pulsed radiofrequency,PRF)联合三氧水注射治疗头面部带状疱疹后神经痛(postherpetic neuralgia,PHN)的疗效。方法:收集航空总医院2016年6月至2022年3月因头面部PHN接受治疗的病人信息,按治疗方法分为四组:鞘内注射组35例、神经干三氧水注射组26例、半月神经节三氧水注射组35例、半月神经节高电压脉冲射频联合三氧水注射组12例,术后3个月和6个月进行随访。采用疼痛视觉模拟评分法(visual analogue scale,VAS)评分、巴罗神经学研究所(Barrow neurological institute,BNI)疼痛评分、匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评估病人疼痛程度与睡眠质量并观察不良反应,痛觉异常由von Frey实验评估。结果:治疗后各时间点VAS、BNI、PSQI评分与治疗前相比均显著降低,且6个月时半月神经节高电压脉冲射频联合三氧水注射组低于其他三组(P<0.05)。结论:6个月内鞘内注射、神经干三氧水注射、半月神经节三氧水注射及脉冲射频联合三氧水注射均可显著缓解疼痛,但6个月时半月神经节高电压脉冲射频联合三氧水注射组效果更佳。

Objective:To compare the efficacy of intrathecal injection,nerve ozone injection,ozone injection around gasserian ganglion and combined with C-arm guided pulsed radiofrequency(PRF)in the treatment of facial postherpetic neuralgia.Methods:Collected the information of patients who suffered from postherpetic neuralgia(PHN)pain in the head and face from June 2016 to 2022 March in department of Anesthesiology,Pain and Sleep Medicine,Aviation General Hospital,then divided into intrathecal injection group of 35 patients,nerve ozone injection group of 26 patients,ozone injection around gasserian ganglion group of 35 patients and PRF combined ozone injection group of 12 patients according to the procedure.The patients were followed up for three months and six months after procedure.Visual analogue scale(VAS),Barrow neurological institute(BNI)pain score and Pittsburgh sleep quality index(PSQI)were used to evaluate pain and sleep quality,and side effects were observed.Tactile abnormalities were assessed by von Frey.Results:The VAS,BNI,and PSQI scores in the four groups were significantly lower than pre-treatment.Compared with the intrathecal injection,nerve ozone injection and ozone injection with gasserian ganglion groups,the VAS,BNI,and PSQI scores of C-arm guided radiofrequency group was lower at 6 months(P<0.05).Conclusion:Intrathecal injection,nerve ozone injection,ozone injection around gasserian ganglion and combined with pulsed radiofrequency are effective therapies for the treatment of head and facial PHN which can significantly relief the pain and improve the quality of sleep,but the effect of PRF combined with ozone group was better after 6 months.