火针结合刺络拔罐治疗带状疱疹后遗神经痛36例

目的:观察火针结合刺络拔罐治疗带状疱疹后遗神经痛的临床疗效。方法:选取本院收治的带状疱疹后遗神经痛患者68例,随机分为治疗组36例和对照组32例。治疗组给予火针结合刺络拔罐治疗,对照组给予毫针针刺治疗。结果:治疗组有效率97.2%,对照组有效率93.8%,治疗组优于对照组(P0.05)。结论:火针结合刺络拔罐治疗带状疱疹后遗神经痛疗效显著。     

Ultrasound-Guided Nerve Block with Botulinum Toxin Type A for Intractable Neuropathic Pain

Neuropathic pain includes postherpetic neuralgia (PHN), painful diabetic neuropathy (PDN), and trigeminal neuralgia, and so on. Although various drugs have been tried to treat neuropathic pain, the effectiveness of the drugs sometimes may be limited for chronic intractable neuropathic pain, especially when they cannot be used at an adequate dose, due to undesirable severe side effects and the underlying disease itself. Botulinum toxin type A (BoNT-A) has been known for its analgesic effect in various pain conditions. Nevertheless, there are no data of nerve block in PHN and PDN. Here, we report two patients successfully treated with ultrasound-guided peripheral nerve block using BoNT-A for intractable PHN and PDN. One patient had PHN on the left upper extremity and the other patient had PDN on a lower extremity. Due to side effects of drugs, escalation of the drug dose could not be made. We injected 50 Botox units (BOTOX^®, Allergan Inc., Irvine, CA, USA) into brachial plexus and lumbar plexus, respectively, under ultrasound. Their pain was significantly decreased for about 4–5 months. Ultrasound-guided nerve block with BoNT-A may be an effective analgesic modality in a chronic intractable neuropathic pain especially when conventional treatment failed to achieve adequate pain relief.     

经皮穿刺球囊压迫治疗三叉神经痛的疗效因素探讨

目的 探讨影响经皮穿刺半月节球囊压迫术治疗原发性三叉神经痛疗效的因素。 方法 回顾性分析我院2015年11月~2018年3月采用经皮穿刺半月节球囊压迫术治疗的200例原发性三叉神经痛患者的临床资料及手术记录,并对患者的疗效进行定期随访,探讨球囊形状、球囊容积、压迫持续时间等参数与患者疗效的关系。结果 术后随访12~40月,平均22.5月。本组术后疼痛即刻消失率92.5%,5%偶尔疼痛,无需服用药物,整体治愈率为97.5%,至随访结束总体有效率为88.5%。术后手术同侧咀嚼肌乏力124例(62%),21例(10.5%)患者出现面部感觉异常,2例(1%)复视(外展神经麻痹),无严重手术并发症发生。分析结果表明,在所有探讨的参数中,球囊形状呈梨形(P<0.001)是影响患者术后疼痛即刻消失及维持患者术后无痛病程的独立预后因素。缩短了球囊的压迫时间后,术后面部感觉异常的发生率明显下降(P=0.035)。结论 球囊形状是影响经皮穿刺半月节球囊压迫术治疗原发性三叉神经痛疗效的决定性参数,在行经皮穿刺球囊压迫术时,应尽量调整球囊位置直至乳头凸向后颅窝的“梨形”出现。     

穿刺冷冻治疗原发性三叉神经痛的初步观察

目的：探讨一种新的三叉神经痛的治疗方法。方法：对35例老年患者采用穿刺冷冻针进行神经孔内冷冻治疗。结果：随访30例，其中25例病人效果满意。结论：该方法创伤小、并发症少、效果可靠，可用于治疗原发性三叉神经痛老年患者。     

下牙槽神经、舌神经干注射阿霉素联合颊神经撕脱治疗第Ⅲ支三叉神经痛的疗效观察

目的:评价下牙槽神经、舌神经干注射阿霉素联合颊神经撕脱治疗三叉神经(Ⅲ支)痛的疗效。方法:对41例三叉神经痛患者进行单纯下牙槽、舌神经干注射阿霉素的治疗,52例进行神经干注射阿霉素联合颊神经撕脱治疗。对2组术后3a、5a的复发率进行χ2检验。结果:单纯注射阿霉素组,37例疼痛症状消失,4例症状缓解;联合颊神经撕脱组,52例疼痛症状全部消失。随访3a,前者的复发率为12.2%,后者为3.8%(P>0.05);随访5a,前者的复发率为21.9%,后者为5.8%(P<0.05);随时间延长,2组间的复发率差异加大。结论:神经干注射阿霉素联合颊神经撕脱术,可提高神经干注射阿霉素治疗三叉神经(Ⅲ支)痛的疗效,减少其复发率。     

CT引导半月神经节射频热凝治疗血管神经关系密切型三叉神经痛的疗效

目的 探讨CT引导半月神经节射频热凝治疗血管神经关系密切型三叉神经痛的临床疗效.方法 选取安徽医科大学第一附属医院疼痛科2015年8月至2019年3月收治的血管神经关系密切型三叉神经痛患者95例,均给予CT引导半月神经节射频热凝治疗.分别于术前及术后1、3、6、12个月,记录患者的视觉模拟评分(VAS),评价患者睡眠质量,统计患者每周卡马西平使用剂量.结果 患者各时间点VAS评分、卡马西平使用剂量及睡眠质量评分进行比较,差异均有统计学意义(P<0.05);患者术后1、3、6、12个月的VAS评分、卡马西平使用剂量及睡眠质量评分均低于术前,差异均有统计学意义(P<0.05).结论 CT引导半月神经节射频热凝适用于血管神经关系密切型三叉神经痛的治疗,可改善患者疼痛,提高患者生活质量,手术方法 较为安全.     

Trigeminal neuraligia. A retrospective survey of a sample of patients in singapore and Malaysia

This survey was undertaken to study the clinical features of trigeminal neuralgia in an Asian population. Demographic data of 44 patients treated at the Dental Faculty of the National University of Singapore and at the University of Malaya were reviewed. The results of the survey were analysed and comparisons made with those of Caucasian patients as reported in other studies where there was a general similarity in the clinical findings. Trigeminal neuralgia presented predominantly in females. Right-sided involvement occurred at a greater frequency, and the peak age at onset was between the sixth and seventh decades of life. The only significant variant in them present sample was the greater involvement of the mandibular branch of the trigeminal nerve rather than the maxillary division. In addition, there was a much greater representation from Chinese patients over Malays as compared with their ratios in general population.     

老年人原发性三叉神经痛得宝松局部注射治疗效果评价

目的:探讨得宝松(复方倍他米松)局部注射治疗老年人原发性三叉神经痛的临床效果,为三叉神经痛提供新的治疗方法。方法:原发性三叉神经痛患者30例,根据疼痛范围行相应神经支局部注射,每个注射点注入得宝松灭菌混悬注射液0.5ml。治疗后3个月内定期复诊,随访时间3年,使用视觉模拟评分法评定患者疼痛程度和治疗效果。结果:30例患者治疗后1个月内三叉神经痛症状有不同程度的减轻,VAS评分疗效优、良、中者分别为43.3%、46.7%和10.0%,治疗后3年VAS评分疗效优、良、中、差者分别为33.3%、40.0%、16.7%和10.0%,3年内复发率为10.0%,平均复发时间分别为26个月,治疗后VAS评分与治疗前相比有显著性差异。患者治疗后无明显感觉降低。结论:得宝松局部注射治疗三叉神经痛方法简单,有效率高,复发率低,无明显毒副作用,是一种安全有效的治疗方法。     

柴胡疏肝散合桃红四物汤加减治疗带状疱疹后遗神经痛120例分析

目的:观察柴胡疏肝散合桃红四物汤加减治疗带状疱疹后遗神经痛的临床疗效。方法:将带状疱疹后遗神经痛患者240例随机分为治疗组、对照组各120例。对照组进行常规西药治疗(维生素B1注射液100 mg、维生素B12注射液500μg,1次/d,肌肉注射;布洛芬片0.3 g,3次/d,口服);治疗组采用中药柴胡疏肝散合桃红四物汤加减治疗,1剂/d。2个疗程20天后观察疗效。结果:治疗组与对照组总有效率分别为93.33%、77.50%,2组比较差异有统计学意义(P0.05);2组疼痛VAS评分比较差异有统计学意义(P0.05)。结论:柴胡疏肝散合桃红四物汤加减治疗带状疱疹后遗神经痛能有效缓解神经痛,临床疗效优于西药常规治疗。     

电针联合雷头风颗粒治疗原发性三叉神经痛临床研究

目的：评价电针联合雷头风颗粒治疗原发性三叉神经痛(primary trigeminal neuralgia, PTN)的临床疗效。方法将符合入选标准的60例PTN患者按病历尾号随机分为2组各30例,对照组口服卡马西平,治疗组在对照组基础上加用电针联合雷头风颗粒。15 d为1个疗程,共治疗3个疗程。采用简化McGill疼痛问卷(A Short Form of the McGill Pain Questionnaire, SF-MPQ)比较治疗前后疼痛评定指数(painratingindex, PRI)、选词数(number of word chosen, NWC)、现时疼痛强度(present painindex, PPI)、视觉模拟量表(Visual Analogue Scale, VAS)分值的变化,评价临床疗效并观察复发率。结果治疗组愈显率为96.7%(29/30),对照组为70.0%(21/30),2组比较差异有统计学意义(χ2＝5.880,P＝0.015)。治疗后,治疗组 PRI[(0.20±0.47)分比(3.33±4.65)分,t＝3.592]、NWC[(0.20±0.48)分比(1.40±1.87)分,t＝3.345]、VAS[(0.20±0.48)分比(1.27±1.66)分,t＝3.321]、PPI[(0.17±0.38)分比(0.90±0.99)分,t＝3.771]、总分[(0.79±1.83)分比(6.90±9.05)分,t＝3.602]分值均低于对照组(P＜0.01);治疗组 PTN 日发作频次[(2.20±1.17)次比(4.27±1.39)次,t＝6.238]低于对照组(P＜0.01)。随访3个月,治疗组复发3例(10.0%),对照组复发17例(56.6%),2组比较差异有统计学意义(χ2＝12.675,P＜0.01)。结论电针联合雷头风颗粒治疗PTN疗效优于卡马西平。