高频神经电刺激引导下温度选择性射频热凝术治疗原发性面肌痉挛患者的疗效及安全性

Safety and efficacy of temperature-selective radiofrequency thermocoagulation guided by high-frequency nerve electrical stimulation in patients with primary hemifacial spasm

目的:探讨高频神经电刺激引导下温度选择性射频热凝术治疗原发性面肌痉挛患者的临床效果及安全性。方法:回顾性收集2018年1月1日至2020年1月1日就诊于长治医学院附属和平医院疼痛科的原发性面肌痉挛患者40例的临床资料,性别、年龄不限,Cohen分级≥3级。所有患者于特定穿刺点经皮穿刺,高频神经电生理刺激(100 Hz、1.0 V)引导下探寻面神经干,不同患者根据疗效,个性化选择不同温度及时间行射频热凝治疗。根据Cohen分级量表评价痉挛程度,记录术前、术毕即刻、术后15 d及术后3、6、12、24个月时Cohen分级,计算治愈率、总有效率,评定术后面瘫程度,统计各时点复发率及面瘫、血肿等不良反应发生情况。采用Pearson相关分析术后面瘫恢复时间与术后面瘫严重程度的关系。结果:与术前相比,其他时点Cohen分级均明显降低( P均<0.05);术后即刻,治疗总有效率达100.0%(40/40例),治愈率87.5%(35/40例),术后15 d及术后3、6、12、24个月时总有效率未见降低,治愈率逐渐降低,术后24个月时治愈率为55.0%(22/40例);术后12、24个月复发率分别为2.5%(1/40例)、7.5%(3/40例);术毕即刻面瘫发生率95.0%(38/40例),其中94.7%(36/38例)为轻中度,且89.5%(34/38例)患者面瘫6个月内恢复,其余患者在1年内全部恢复;所有患者均未见明显血肿及局麻药反应等并发症。术后面瘫恢复时间与术后即刻面瘫评分正相关( r=0.897, P<0.05)。 结论:高频神经电刺激引导下温度选择性射频热凝术治疗原发性面肌痉挛有较好的治疗效果,且安全性高。

Objective To evaluate the clinical efficacy and safety of temperature-selective radiofrequency thermocoagulation guided by high-frequency nerve electrical stimulation for treatment of patients with primary hemifacial spasm(HFS).Methods A retrospective analysis of 40 patients with primary HFS were performed,in Department of Pain Medicine,Heping Hospital Affiliated to Changzhi Medical College from 1st January 2018 to 1st January 2020,gender and age unlimited,Cohen classification≥grade 3.All patients were treated with percutaneous puncture at a specific point guided by high frequency electrophysiological stimulation(100 Hz,1.0 V)to explore the facial nerve stem,and different temperature and time were selected according to their efficacy.The degree of spasticity was evaluated and recorded before the operation,immediately,15 days and 3,6,12,24 months after the operation according to the Cohen classification,and the cure rate and total effective rate were calculated at every time point.The degree of postoperative facial paralysis was assessed and the recurrence rate and the side effects such as facial paralysis and hematoma were respectively recorded before and after the operation.The relationship between the duration of recovery and the severity of postoperation facial paralysis and preoperative muscle spasm were analyzed by Pearson correlation.Results The Cohen classification was obviously decreased after the operation immediately,15 days and 3,6,12,24 months compared with before the operation.The cure rate was 100.0%(40/40 cases)and the effective rate was 87.5%(40/40 cases)after the operation immediately.The cure rate did not decrease,but the effective rate was gradually decreased after the operation.The cure rate was 55.0%(22/40 cases)at 24 months,and the recurrence rates were 2.5%(1/40 cases)and 7.5%(3/40 cases)at 12,24 months respectively.The incidence of facial paralysis was 95.0%(38/40 cases)after the operation immediately,of which 94.7%(36/38 cases)was mild to moderate,89.5%(34/38 cases)patients recovered within 6 months,and all the remaining patients recovered within one year.None of the patients had significant hematoma and complications such as local anesthetic reaction.The duration of recovery has a strong correlation with the severity of postoperation facial paralysis(r=0.897,P<0.05).Conclusion Temperature-selective radiofrequency thermocoagulation guided by high-frequency nerve electrical stimulation is a safe and effective method in the treatment of patients with primary hemifacial spasm.