短时程脊髓电刺激治疗爆发痛合并触诱发痛的急性期带状疱疹的临床研究

目的探讨短时程脊髓电刺激(temporary spinal cord stimulation, tSCS)治疗爆发痛合并触诱发痛的急性期带状疱疹的临床疗效。方法回顾性地分析同济大学附属第十人民医院疼痛科2020年1月—2020年12月收治的52例接受tSCS治疗的爆发痛合并触诱发痛的急性期带状疱疹患者的临床资料，评估在治疗前、治疗后3d、7d、14d、3个月、6个月的总体疼痛情况(numerical rating scale, NRS)评分、(simple McGill scores, McGill)评分、爆发痛情况(发生率、NRS评分、次数以及持续时间)、触诱发痛情况(发生率、分级)、术后不良反应等；评估在治疗前、治疗后7d、3个月、6个月的睡眠时长、睡眠中醒来次数、疼痛障碍指数(pain disorder index, PDI)、功能状态评分(Karnofsky score, KPS)、抑郁症筛查量表(patient health questionnaire depression module scale, PHQ-9)和焦虑症筛查量表(generalized anxiety disorder-7 scale, GAD-7)等。结果与治疗前相比，治疗后3d、7d、14d、3个月、6个月的总体疼痛NRS评分、总体疼痛MCGILL评分、静息痛NRS评分明显降低(均P<0.001)；与治疗前相比，治疗后3d、7d、14d、3个月、6个月的的爆发痛NRS评分明显降低(均P<0.05)，治疗后14d、3个月、6个月时的爆发痛次数以及持续时间都明显降低(均P<0.05)；与治疗前比较，患者治疗后7d、14d、3个月、6个月时的触诱发痛的分级都明显降低，差异均有统计学意义(均P<0.05)；与治疗前相比，治疗后14d、3个月、6个月的PDI评分明显降低(P<0.05)；与治疗前相比，治疗后14d、3个月、6个月的PHQ-9评分和GAD-7评分都明显减少(P<0.05)，与术前的药物使用情况相比，治疗后各镇痛药使用人数普遍呈下降趋势；术中及整个随访期间未观察到严重不良事件。结论短时程脊髓电刺激对爆发痛合并触诱发痛的急性期带状疱疹具有较好的临床疗效。     

芎芷石膏汤治疗原发性三叉神经痛

原发性三叉神经痛是三叉神经分布区内短暂的发作性剧痛,多发于中老年人,40岁以上患者占70%~80%,发作时表现为面颊上下颌及舌部明显的剧烈电击样、针刺样、刀割样疼痛,持续时间短,突发突止,间歇期完全正常。中医将其归属于"面痛"范畴,多从风热立论,笔者跟随导师临证过程中,发现《医宗金鉴》的芎芷石膏汤治疗风热上犯型原发性三叉神经痛效果显著。     

Eficacia de la terapia con señales electromagnéticas pulsadas y transmitidas de manera dieléctrica monopolar en procesos dolorosos asociados a esclerosis múltiple. Estudio piloto

IntroductionPain is highly prevalent in patients with multiple sclerosis (MS); it is chronic in 50% of cases and is classified as nociceptive, neuropathic, or mixed-type. Pain affects quality of life, sleep, and the activities of daily living. Electrotherapy is an interesting alternative or complementary treatment in the management of pain in MS, with new innovations constantly appearing.Material and methodsThis study evaluates the effectiveness of treatment with monopolar dielectric transmission of pulsed electromagnetic fields (PEMF) for pain associated with MS. We performed a randomised, placebo-controlled clinical trial including 24 patients, who were assessed with the Brief Pain Inventory, the Multiple Sclerosis International Quality of Life questionnaire, the Beck Depression Inventory, and the Modified Fatigue Impact Scale.ResultsStatistically significant improvements were observed in maximum and mean pain scores, as well as in the impact of pain on work, personal relationships, and sleep and rest. Not significant differences were found between the treatment and placebo groups.ConclusionsTreatment with PEMF may be effective in reducing pain in patients with MS, although further research is necessary to confirm its effectiveness over placebo and to differentiate which type of pain may be more susceptible to this treatment.     

亚甲蓝甘油合剂封闭治疗三叉神经痛108例

目的观察亚甲蓝甘油合剂封闭治疗三叉神经痛的临床疗效并探讨其治疗机制。方法按国际头面痛学会分类委员会确定的诊断标准,108例原发性三叉神经患者随机分为两组:A组为亚甲蓝甘油合剂组(n=54),B组为单纯甘油合剂组(n=54);采用徐贵印推荐的三维测角穿刺半月神经节进行封闭治疗,对治疗后1周、3个月和2年分别进行疗效评判和随访观察。结果两组治疗后1周、3个月优良率比较差异无统计学意义(P>0.05),两年后优良率比较差异有统计学意义(P<0.05);两组并发症没有明显差异,2例出现视力下降,3例因解剖变异未能穿刺成功,仅在卵圆孔周围进行了注射,外加眶下孔以及骸孔封闭。结论亚甲蓝甘油合剂用于治疗三叉神经痛远期疗效优于单纯甘油合剂,且亚甲蓝对神经未见明显损害(经2年随访)。     

Choice of open or percutaneous procedures in the surgical treatment of trigeminal neuralgia

The aim of this study was to define criteria for the selection of patients for percutaneous or open operations for the cure of drug-resistant trigeminal neuralgia (TN). Trigeminal percutaneous radiofrequency thermorhizotomy (TPRT) has an established place because of its safety in elderly patients, while microvascular decompression (MVD) has appeal in younger patients beause of its non-destructive nature and because it attacks what is believed to be the primary etiology of tic douloureux. Nevertheless, MVD is a successful operation only when true neurovascular conflict (NVC) is ascertained, rather than a simple arterial loop and neurovascular contract. Probably, many immediate failures and early relapses are the consequence of the inadequate patient selection for MVD on the presumption that this operation is in any case the ideal cure. The inadequate selection can be explained by the difficult preoperative diagnosis of NVC in the past. Indeed, angiography and computed tomography showed the neurovascular contact but not the size of compression. Fortunately, today magnetic resonance imaging is a reliable instrument to ascertain NVC. So, the diatribe between the supporters of percutaneous techniques and MVD can be concluded with the following: (1) percutaenous techniques are indicated for patients without demonstrated NVC (including patients with TN in multiple sclerosis) and in those with NVC if MVD is contraindicated by ill-health or refused by the informed patient; and (2) MVD is incated for patients with ascertained NVC who are in good health and who, informed of the surgical risk, favor this operation desiring no sensory deficit. Received: 23 June 2001 / Accepted in revised form: 24 August 2001     

神经内结缔组织增生与三叉神经脱髓鞘的关系

目的探讨三叉神经痛（trigeminal neuralgia，TN）患者三叉神经患支内结缔组织改变与神经脱髓鞘的关系。方法对手术切取的TN患者三又神经患支标本及对照标本行髓鞘染色，在光镜及电镜下观察神经横截面形态改变，并采用图像分析仪进行半定量测量。结果形态观察及图像分析结果都显示TN患者三叉神经患支明显脱髓鞘，神经内结缔组织显著增生，F检验证实二者存在显著线性正相关。结论TN患者三叉神经惠支内神经内结缔组织增生，可能是TN发生的重要机制之一。     

应用卵圆孔定位仪治疗三叉神经痛

目的总结卵圆孔定位仪在选择性经皮温控射频热凝治疗三叉神经痛的应用方法和技巧。方法对三叉神经第Ⅱ、Ⅲ支疼痛者或第Ⅰ、Ⅱ、Ⅲ支同时疼痛者应用Hartel前入路半月神经节射频热凝治疗,其中260例患者应用三叉神经卵圆孔定位仪辅助定位,对39例患者术中应用X线或三维CT进行卵圆孔靶点验证。结果所有病例穿刺成功。术后即刻疗效:优良206例,良好42例,无疗效12例,总有效率95.4%,无严重并发症发生。结论卵圆孔定位仪可用于射频热凝治疗三叉神经痛的辅助定位,可以提高穿刺的成功率和安全性。     

经乙状窦后入路显微手术治疗继发性三叉神经痛37例

目的探讨经乙状窦后入路显微手术治疗桥小脑角占位性病变引起的继发性三叉神经痛的疗效。方法回顾分析我院2000年10月～2006年7月37例继发性三叉神经痛的临床资料，其中胆脂瘤18例，脑膜瘤8例，听神经瘤6例，三叉神经鞘瘤5例，均经乙状窦后入路显微手术切除肿瘤。结果肿瘤全切23例，次全切除10例，部分切除4例。35例疼痛症状消失（32例立即消失，3例术后2个月消失），随访3个月～5年无复发；2例无效。发生暂时性面瘫6例，面部麻木6例，无颅内感染及脑脊液漏。结论经乙状窦后入路显微手术是治疗继发性三叉神经痛安全有效的方法。     

原发性三叉神经痛的LEKSELL-C伽玛刀治疗

目的 探讨伽玛刀治疗原发性三叉神经痛的方法和效果.方法 对28例原发性三叉神经痛采用LEKSELL-C型伽玛刀治疗,均沿三叉神经走行在三叉神经根近桥脑处选择双靶点治疗.中心剂量75～85Gy,50%等剂量线限定靶点.结果 随访3～11个月,疼痛消失时间平均在术后3.5个月.按疼痛缓解评分,在随访时点,总有效率为96%.结论 LEKSELL-C型伽玛刀是治疗原发性三叉神经痛安全和有效的方法之一.     

三维CT及X线卵圆孔定位射频热凝治疗顽固性三叉神经痛

目的：探讨三维CT及X线卵圆孔定位在三叉神经痛射频热凝治疗中的应用及手术技巧。方法：Hartel前入路穿刺法，仰卧位，对38例三叉神经痛病人，于射频热凝治疗术中应用三维CT及X线卵圆孔定位，以明确卵圆孔的位置，调整穿刺针的方向和深度，然后进行温控热凝射频治疗。结果：穿刺针均位于卵圆孔内，病人疼痛即刻缓解，无严重并发症发生。结论：三维CT及X线卵圆孔定位弥补了徒手穿刺的缺陷，提高了卵圆孔穿刺的成功率和精确性，增加了操作的安全性，降低了并发症的发生，具有一定的学术价值，可供临床推广应用。