射频穿刺针个体化按需折弯器的制作及临床应用

Fabrication of a radiofrequency needle bending device and its clinical application

目的设计对射频穿刺针进行个体化折弯仪器,观察其在CT引导下圆孔穿刺效果。方法折弯器制作:取厚度5 mm不锈钢板材,裁成直径90 mm半圆,分为2个1/4圆,将一个1/4圆铣低1.2 mm,以5°为单位标出0°～90°的圆弧刻度,将另一1/4圆底边侧铣出一条宽、深各1.2 mm的沟槽并标上长度刻度。使用方法:用CT半冠状位对三叉神经V2支痛患者圆孔区进行层厚3 mm扫描,选取适当层面,用CT工具尺由穿刺靶点紧贴上颌窦外侧壁到穿刺点拉直线,若有蝶骨阻挡,则由圆孔外口再向穿刺点另拉一直线,测两直线夹角α。将普通射频针尖插入折弯器的沟槽内5～8 mm,向针尖斜面对侧扳折至针身与α角重叠,则该针即为该患者个体化射频穿刺针。随后在CT引导下按设计的穿刺路径,达圆孔外口时针尖弧度转向前上,越过外口后将弧度转向后下,送入圆孔内。结果 215例圆孔射频患者中,65例患者有蝶骨阻挡,需用折弯器对射频针进行塑型,弯折角α值为11°～32°(18.9°±4.2°)。使用弯针后针尖均能到达靶点,射频热凝后V2支疼痛完全消失,无一例波及V1支或V3支。结论经皮颧弓下入路圆孔穿刺三叉神经V2支射频时,30.2%的患者若有蝶骨大翼阻挡,使用自制塑型折弯器可实现对直射频针的个体化塑型弯折,保证射频针尖能越圆孔外口蝶骨阻挡进入圆孔内而达到理想的射频治疗效果。

Objective To design and make a radiofrequency needle bending device for individual needs during the radiofrequency thermal lesioning surgery, and observe the convenience of the bent needle passing through the foramen ovale during the radiofrequency Lesion for V2 branch of trigeminal neuralgia guided by CT. Methods Designing and making of bending device: the 5 mm thickness stainless steel plate was cut into a semicircle of 90 mm diameter, then divided into two 1/4;one of 1/4 circular was milled to reduce 1.2 mm, and another one of 1/4 circular was also milled to get a groove with a width and depth of the 1.2 mm round the bottom, ARC length scale(0 degrees to 90 degrees, interval 5 degrees) was marked on the device. Methods of use: the patients with V2 branch of trigeminal nerve pain received 3 mm thick layer semi-coronal CT scan of the foramen ovale area. We selected the appropriate CT images, and use CT software tool ruler pull line around the lateral wall of the maxillary sinus from puncture target to surface of the skin, if meet sphenoid bone, pull another line from the mouth of foramen ovale to the point of puncture at surface of the skin, then measured the α angle between the two lines. The common radiofrequency needle was inserted into the groove of bending device for 5 to 8 mm as needed, and bent it slightly to the side of slope of needle tip until the needle reached theαangle, thus the needle was facing the individual need. Under the guidance of CT, the needle was punctured according to the designed path, when it reached the mouth of the foramen ovale, turned its point to make a anterosuperior direction for the curve of needle, when the needle passed through the mouth of the foramen ovale, then turned its point to make a posterior inferior direction for the curve of needle. Results Among the 215 cases of radiofrequency thermal lesioning for V2 branch of trigeminal neuralgia, 65 cases who met sphenoid block used the bending device to shape the needle for individual need, the bended angle alpha value was from 11° to 32°(18.9°±4.20°). The tip of the curved needle can smoothly reach the target point;radiofrequency thermal lesioning was well finished. V2 pain disappeared completely after radiofrequency, without the injury of V1 and V3. Conclusion When the V2 branch of the trigeminal nerve was punctured through the zygomatic approach, 30.2% of the patients have the obstruction of the sphenoid bone, and the straight needle is difficult to get into the puncture target in the foramen ovale. The individual bent needle by this invented bend device can make the RF tip get to accurate position and guarantee the effect treatment.