DSA引导下经圆孔外口与经卵圆孔射频治疗三叉神经上颌支神经痛的疗效比较

Comparison of clinical efficacy of DSA-guided radiofrequency thermocoagulation via foramen rotundum or foramen ovale approach in the treatment of maxillary branch trigeminal neuralgia

目的 比较数字血管减影(DSA)引导下经圆孔外口与经卵圆孔射频治疗三叉神经上颌支神经痛的临床疗效.方法 选取三叉神经上颌支神经痛患者86例,按照入路方式的不同将其分为圆孔组和卵圆孔组,每组43例.圆孔组给予经皮侧方入路穿刺圆孔外口射频治疗,卵圆孔组给予经Hartel前入路穿刺卵圆孔射频治疗,比较两组患者治疗前后的VAS评分、临床疗效、复发率及并发症.结果 圆孔组患者治疗后1周、3个月、半年时VAS评分分别为(1.2±0.8)、(1.3±1.1)、(1.5±1.3);卵圆孔组则分别为(1.3±0.7)、(1.3±1.0)、(1.6±1.2),均较治疗前明显降低(P＜0.05);两组患者治疗后各时点的VAS评分及半年内的复发率差异无统计学意义(P＞0.05);两组治疗的优良率分别为95.3％(41/43例)与97.7％ (42/43例),差异无统计学意义(P＞0.05).圆孔组和卵圆孔组并发症发生率分别为9.3％(4/43例)与34.9％(15/43例),差异具有统计学意义(P＜0.05).结论 DSA引导下经圆孔外口与经卵圆孔射频治疗三叉神经上颌支神经痛均可有效缓解患者疼痛,但前者安全性更高.

Objective To compare the clinical efficacy of DSA-guided radiofrequency thermocoagulation via foramen rotundum or foramen ovale approach in the treatment of maxillary branch trigeminal neuralgia.Methods Eighty-six patients with maxillary branch trigeminal neuralgia were divided into foramen rotundum group and foramen ovale group according to the different approach.The patients were treated by radiofrequency thermocoagulation via the foramen rotundum approach in foramen rotundum group,via foramen oval approach in foramen ovale group.VAS,clinical efficacy,recurrence rate and complications of the two groups were compared.Results VAS was (1.2+0.8),(1.3+1.1) and (1.5+1.3) at one week,3 months and 6 months after the treatment in forameu rotundum group respectively,(1.3+0.7),(1.3+1.0),and (1.6+1.2) in foramen ovale group respectively,with significant difference as compared with pre-treatment (P＜0.05).There was no statistical difference for VAS between the two groups in each time point after the treatment (P＞0.05).The excellent and good rate was 95.3％ (41/43 cases) and 97.7％ (42/43 cases) in the foramen rotundum group and foramen ovale group respectively,without significant difference (P＞0.05).There was no statistical difference for recurrence rate within half a year in the two groups (P＞0.05).The incidence of complications was 9.3％ (4/43 cases) and 34.9％ (15/43 cases) in foramen rotundum group and foramen ovale group respectively,with significant difference (P＜0.05).Conclusion DSA-guided radiofrequency thermocoagulation via foramen rotundum or foramen ovale approach can all effectively relieve maxillary branch trigeminal neuralgia,but the former is safer.