经圆孔与卵圆孔行 CT 引导射频热凝术治疗 V2 型原发性三叉神经痛的疗效与安全性比较。

Comparison of Efficacy and Safety of CT-Guided Radiofrequency Thermocoagulation Through Foramen Rotundum Versus Foramen Ovale for V2 Primary Trigeminal Neuralgia.

机构信息

Department of Pain Management, Shengjing Hospital of China Medical University, Shenyang, China.

出版信息

Pain Physician. 2021 Dec;24(8):587-596.

Abstract

BACKGROUND

Primary trigeminal neuralgia (TN) is one of the most severe facial pain syndromes. TN affects patients' quality of life and, when severe, can lead to depression and increase social burden.

OBJECTIVES

This retrospective study aimed to compare efficacy and safety of computed tomographic (CT)-guided percutaneous radiofrequency thermocoagulation (RFT) through the foramen rotundum (FR) versus through the foramen ovale (FO) for treatment of maxillary division (V2) TN.

STUDY DESIGN

A prospective study.

SETTING

Shengjing Hospital of China Medical University.

METHODS

Seventy patients with V2 TN were randomly assigned to 2 groups: RFT-FR group (n = 35) and RFT-FO group (n = 35). Visual Analog Scale (VAS), the Medical Outcomes Study 36-Item Short-Form Health Survey, the total efficacy, complications, and recurrence rate were assessed before and after surgery at different time points.

RESULTS

Compared with the preoperative VAS, the postoperative VAS in the RFT-FR and RFT-FO groups both decreased significantly (P < 0.05). There was no significant difference in VAS between the 2 groups (P > 0.05); in both groups quality of life improved to varying degrees after RFT. In the RFT-FO group, the physical component summary (PCS) and mental component summary (MCS) were significantly lower than in the RFT-FR group at 1 week, 2 weeks and 1 month (P < 0.05). After 3 months, the PCS and MCS of the RFT-FO group gradually increased, so the 2 groups no longer differed significantly (P > 0.05). The total incidence of complications in the RFT-FR and RFT-FO groups was 20.0% (7/35) and 62.9% (22/35), respectively, and differed significantly (P < 0.05).

LIMITATIONS

This study cohort size is small, but we will gradually increase the number of patients later. Second, there may be acquiescence bias or response bias. Third, the punctures under the more commonly used C-arm imaging guidance deserve to be evaluated in the future.

CONCLUSIONS

CT-guided RFT through the FR and FO are both an effective, minimally invasive treatments for V2 TN that can relieve pain effectively.

摘要

背景

原发性三叉神经痛（TN）是最严重的面部疼痛综合征之一。TN 影响患者的生活质量，严重时可导致抑郁并增加社会负担。

目的

本回顾性研究旨在比较经圆孔（FR）和卵圆孔（FO）引导的计算机断层扫描（CT）引导下经皮射频热凝（RFT）治疗上颌支（V2）TN 的疗效和安全性。

研究设计

前瞻性研究。

设置

中国医科大学盛京医院。

方法

将 70 例 V2 TN 患者随机分为 2 组：RFT-FR 组（n=35）和 RFT-FO 组（n=35）。分别于术前及术后不同时间点采用视觉模拟评分（VAS）、健康调查简表 36 项（SF-36）评估 VAS、总体疗效、并发症及复发率。

结果

与术前 VAS 相比，RFT-FR 组和 RFT-FO 组术后 VAS 均明显降低（P<0.05）；2 组间 VAS 差异无统计学意义（P>0.05）；RFT 后 2 组生活质量均有不同程度改善。RFT-FO 组术后 1 周、2 周及 1 个月时的生理成分综合评分（PCS）和心理成分综合评分（MCS）明显低于 RFT-FR 组（P<0.05）；RFT-FO 组术后 3 个月时 PCS 和 MCS 逐渐升高，2 组间差异无统计学意义（P>0.05）。RFT-FR 组和 RFT-FO 组并发症总发生率分别为 20.0%（7/35）和 62.9%（22/35），差异有统计学意义（P<0.05）。