三叉神经萎缩和神经脑桥夹角与原发性三叉神经痛患者经皮穿刺射频热凝术后复发的关系

The relationship and clinical risk assessment between trigeminal nerve atrophy and pontine angle and recurrence after percutaneous radiofrequency thermocoagulation in ITN patients

目的探讨原发性三叉神经痛(INT)患者采用经皮穿刺射频热凝术后出现疼痛复发与三叉神经萎缩程度和神经脑桥夹角的关系。方法选取青岛大学附属青岛市海慈医院(青岛市中医医院)2020年1月至2021年12月收治的297例INT患者进行回顾性分析。所有患者均接受经皮穿刺射频热凝术治疗,对患者随访24个月。其中56例患者术后出现疼痛复发(复发组)、241例患者未出现术后疼痛复发(非复发组)。结果三叉神经根长度、三叉神经萎缩程度、二者联合应用绘制ROC曲线,其预测INT患者采用经皮穿刺射频热凝术后出现疼痛复发的AUC值分别为0.553、0.750、0.861;logistic回归模型结果显示:三叉神经根长度缩短(OR=0.624,P=0.038)、三叉神经萎缩程度增大(OR=2.257,P=0.000)、责任血管类别为多血管压迫(OR=1.842,P=0.019)、基线疼痛呈重度疼痛(OR=1.714,P=0.000)是INT患者采用经皮穿刺射频热凝术后出现疼痛复发的独立危险因素(P<0.05)。结论INT患者手术前接受薄层MRI扫描,其三叉神经萎缩程度对患者射频热凝术后出现疼痛复发具有更高的预测价值,三叉神经根长度、三叉神经萎缩程度与患者术后出现疼痛复发具有一定的相关性。

Objective Exploring the relationship between pain recurrence after percutaneous radiofrequency thermocoagulation and the degree of trigeminal nerve atrophy and pontine angle in patients with primary trigeminal neuralgia(INT).Methods A retrospective analysis was conducted on 297 patients with INT admitted to Qingdao Haici Hospital Affiliated to Qingdao University(Qingdao Traditional Chinese Medicine Hospital)from January 2020 to December 2021.All patients received percutaneous radiofrequency thermocoagulation surgery in our hospital.They were followed up for 24 months,during which 56 patients experienced pain recurrence after surgery(recurrence group),while 241 patients did not experience postoperative pain recurrence(non-recurrence group).Results The length of the trigeminal nerve root,degree of trigeminal nerve atrophy,and the combined application of the two were used to draw ROC curves.The AUC values predicted for pain recurrence in INT patients after percutaneous radiofrequency thermocoagulation were 0.553,0.750,and 0.861,respectively.The results of the logistic regression model showed that shortened trigeminal nerve root length(OR=0.624,P=0.038),increased degree of trigeminal nerve atrophy(OR=2.257,P=0.000),multi vessel compression(OR=1.842,P=0.019),and severe baseline pain(OR=1.714,P=0.000)were independent risk factors for pain recurrence in INT patients after percutaneous radiofrequency thermocoagulation(P<0.05).Conclusions INT patients undergo thin-layer MRI scans before surgery,and the degree of trigeminal nerve atrophy has a higher predictive value for pain recurrence after radiofrequency thermocoagulation.The length of trigeminal nerve roots and degree of trigeminal nerve atrophy are correlated with postoperative pain recurrence in patients.