半月神经节联合射频治疗三叉神经痛的临床研究

目的:观察CT引导下半月神经节脉冲射频联合连续射频治疗三叉神经痛的临床效果。方法:90例原发性三叉神经痛患者随机分为对照组(CRF组,单纯采用75℃连续射频进行治疗,N=45)和联合射频组(采用42℃脉冲射频和75℃连续射频进行治疗,CRF+PRF组,N=45),比较治疗前、治疗后1d、3d、7d、3个月、6个月、1年、2年的视觉模拟评分(VAS)、疼痛缓解率,以及治疗前、治疗后3个月、6个月、1年、2年的生存质量评分(QOL)、麻木评分和并发症发生率。结果:治疗后两组患者的VAS评分均较治疗前明显降低(P<0.05),随访2年两种方法治疗的有效率均达100%(P>0.05);治疗后7d联合射频组的VAS显著低于CRF组(P<0.05),但治疗后2年联合射频组的VAS评分较对照组明显增高(P<0.05);治疗后2年联合射频组的麻木发生率和麻木评分均较对照组明显降低(P<0.05)。结论:半月神经节脉冲射频联合连续射频可有效缓解三叉神经痛,尽管短期疗效超过了连续射频,但长期疗效低于连续射频,并发症的发生率明显低于连续射频。     

脉冲射频刺激联合普瑞巴林治疗带状疱疹后遗三叉神经痛的临床效果

目的探讨脉冲射频刺激联合普瑞巴林治疗带状疱疹后遗三叉神经痛的临床效果,为临床治疗该病提供参考依据。方法选取我科室于2017年2月至2020年2月收治的358例带状疱疹后遗三叉神经疼痛者为研究对象,以随机数字表法将其分为对照组和观察组,各179例。对照组给予普瑞巴林治疗,观察组给予脉冲射频刺激联合普瑞巴林治疗。比较两组的疼痛程度、机体神经肽水平、生活质量及治疗过程中的不良反应发生情况。结果治疗后1、2、3、4周,观察组的VAS评分均明显低于对照组,差异具有统计学意义(P<0.05)。治疗后,观察组的SP、CGRP水平明显低于对照组,β-EP水平明显高于对照组,差异具有统计学意义(P<0.05)。治疗后,两组的生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康评分均较治疗前明显升高,且观察组高于对照组,差异具有统计学意义(P<0.05)。两组患者治疗过程中的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论脉冲射频刺激联合普瑞巴林应用于带状疱疹后遗三叉神经痛的治疗中,可改善患者体内的神经肽水平,迅速缓解疼痛,提升生活质量,且不增加不良反应,安全性好,值得推广。     

A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛的临床疗效

目的：观察A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛的临床效果。方法：选取33例三叉神经痛或带状疱疹后神经痛患者，进行疼痛区域A型肉毒毒素皮下或皮内注射治疗，评估患者治疗时、治疗2周后、治疗3个月后疼痛情况（NRS）、睡眠状况及生活质量（QOL），判断治疗效果，观察药物不良反应。结果：患者使用A型肉毒毒素治疗2周后、3个月后疼痛评分、睡眠评分显著低于治疗时（P<0.05），生活质量显著高于治疗时（P<0.05），治疗效果好，不良反应少。结论：A型肉毒毒素治疗三叉神经痛和带状疱疹后神经痛效果显著，可成为神经病理性疼痛治疗的一种新途径。     

Duration of attacks of first division trigeminal neuralgia

Objective measurements of duration of attacks have been performed in 8 (5 female and 3 male) patients suffering from primary first division (V-1) trigeminal neuralgia. The mean age of the patients was 67.5 +/- 11.4 years, and the mean age at onset 64.0 +/- 9.7 years. During the study the patients were off treatment. A total of 192 attacks were witnessed by the authors and exactly timed by a stop-watch. The duration of attacks ranged from 2 to 32 s, with a mean of 6.5 +/- 6.1 s. The unweighted mean was 8.8 +/- 5.7 s, with a range of 2.4-17.5 s. With the present data the duration of attacks of V-1 neuralgia has been exactly determined, and the clinical distinction of V-1 neuralgia from other shortlasting headaches, particularly from SUNCT, has been substantially clarified.     

Comparison of High‐voltage‐ with Standard‐voltage Pulsed Radiofrequency of Gasserian Ganglion in the Treatment of Idiopathic Trigeminal Neuralgia

Although pulsed radiofrequency treatment (PRFT) has been used to treat trigeminal neuralgia (TN) safely, satisfactory improvement is lacking. Recently, much attention has been paid to the PRFT dose and intra‐operative parameters. It has been reported that high‐voltage PRFT could significantly reduce discogenic pain. However, there is no study investigating the effects of high‐voltage PRFT on TN. The aim of this prospective, randomized, double‐blinded study was to evaluate the efficacy and safety of high‐voltage PRFT in comparison with standard‐voltage PRFT for idiopathic TN. Sixty severe TN patients were randomly assigned to 2 groups treated with CT‐guided standard‐ or high‐voltage‐pulsed radiofrequency (RF) of Gasserian ganglion, respectively, between January 2012 and July 2012. Numeric Rating Scales (NRS), carbamazepine dose, and side effects were evaluated at day 1, weeks 1 and 2, months 1, 3, and 6, and 1 year postoperative. There were 27 patients in the standard‐voltage group and 26 patients in the high‐voltage group who completed the 1‐year follow‐up study. The effective rates in the standard‐voltage and high‐voltage PRFT groups were 41% and 69%, respectively, at 1, 3, and 6 months postoperative (P = 0.037). The effective rate in the standard‐voltage group decreased to 19% at 1‐year postoperative, while in the high‐voltage group remained at 69% (P = 0.000). No significant side effects were detected in both groups. In conclusion, CT‐guided high‐voltage PRFT is an effective and safe interventional therapeutic choice for idiopathic TN patients.     

Objective assessment of autonomic signs during triggered first division trigeminal neuralgia

A total of 26 episodes of V-1 trigeminal neuralgia attacks have been recorded in two female patients. Autonomic phenomena were assessed according to a semiquantitative scale. Attacks lasted 17 +/- 5 s. Mild lacrimation without conjunctival hyperaemia, rhinorrhea or ptosis was observed, even in relatively long lasting episodes. This is in clear contradiction with SUNCT (shortlasting, unilateral, neuralgiform headache with conjunctival injection, tearing and rhinorrhea) attacks that are always dramatically accompanied by both lacrimation and conjunctival injection of the symptomatic side from the very onset of symptoms. Carbamazepine provided complete and sustained relief of symptoms in both patients. Herein we will show differential autonomic features of V-1 trigeminal neuralgia vs. SUNCT that will both aid the clinician to distinguish both syndromes and stress that both entities are nosologicaly different.     

加巴喷丁治疗原发性三叉神经痛临床观察

目的：研究分析加巴喷丁治疗原发性三叉神经痛的临床作用。方法选取本院2013年8月至2015年11月所收治的39例原发性三叉神经痛病患,分为对照组20例（选用中医治疗）以及观察组19例（选用加巴喷丁治疗）两组,比对观察组和对照组不同治疗方式下的治疗效果和不良反应。结果经比对结果显示,对照组的治疗总有效率为13（65．21％）显然比观察组的18（94．73％）低,差异具有统计学意义χ2＝4．27（ P＜0．05）。结论加巴喷丁用于治疗原发性三叉神经痛有一定的临床作用,能够显著改善患者的病症状况,缩短治疗时间,且不良反应较小,有利于病患的身体快速恢复提高生活质量,值得在临床中进一步普及和运用。     

经皮穿刺三叉神经半月节射频热凝加得宝松注射治疗原发性三叉神经痛

目的：探讨经皮穿刺三叉神经半月节射频热凝加得宝松注射治疗原发性三叉神经痛的临床疗效。方法：原发性三叉神经痛患者151例,随机分为观察组76例和对照组75例,观察组采用Hartel前入路穿刺法,在CT引导下经皮穿刺三叉神经半月节射频热凝加得宝松注射治疗。对照组采取单纯内科药物治疗。结果：观察组1次射频治疗后达显效54例、有效19例;对照组治疗10 d后,显效及有效分别为47例、17例,观察组总有效率明显高于对照组（96.1%、85.3%,P〈0.05）。随访0.5-2年,观察组复发率明显低于对照组（5.6%、36.2%,P〈0.05）。结论：CT引导下经皮穿刺三叉神经半月节射频热凝加得宝松注射能明显缓解原发性三叉神经痛的临床症状,降低复发率。     

Compression of the trigeminal ganglion produces prolonged nociceptive behavior in rats

The present study is the first demonstration of prolonged nociceptive behavior in the trigeminal region following compression of the trigeminal ganglion in rats. Experiments were carried out on male Sprague–Dawley rats mounted onto a stereotaxic frame under pentobarbital sodium anesthesia. For compression of the trigeminal ganglion, a 4% agar solution (8μl) was injected into the trigeminal ganglion through a stainless steel injector (24 gauge), which extended 2mm beyond the end of a guide cannula (21 gauge). Following agar injection, the injector and guide cannula were removed. In the control group, rats were sham operated without agar injection. Air‐puff thresholds (mechanical allodynia), pin prick responses (mechanical hyperalgesia), and spontaneous scratching behavior were examined 3 days before surgery and at 3, 7, 10, 14, 17, 21, 24, 30, and 40 days after surgery. Data were analyzed using a repeated measures ANOVA followed by multiple group comparisons using the LSD post‐hoc test. Air‐puff thresholds significantly decreased after compression of the trigeminal ganglion. Mechanical allodynia was established within 3 days and lasted beyond postoperative day 24. Mechanical hyperalgesia was also evident 3 days after compression and persisted until the 40th postoperative day. Although mechanical allodynia and hyperalgesia appeared bilaterally, the ipsilateral side was significantly more sensitive. Intraperitoneal treatment with carbamazepine significantly blocked mechanical allodynia produced by compression of the trigeminal ganglion. These findings suggest that prolonged nociceptive behavior following compression of the trigeminal ganglion may mimic trigeminal neuralgia in this animal model.     

背根神经节脉冲射频术联合椎间孔注射臭氧及复合液治疗带状疱疹后神经痛的效果

目的探讨背根神经节脉冲射频术联合椎间孔注射臭氧及复合液治疗带状疱疹后神经痛(PHN)的效果。方法将本院收治的88例PHN患者根据不同治疗方法分为对照组(n=44)和观察组(n=44)。两组患者均采用背根神经节脉冲射频术治疗,观察组在此基础上给予椎间孔注射臭氧及复合液治疗。比较两组的治疗效果。结果治疗后1、3个月,两组患者的PRI、VAS、PPI评分、SF-MPQ总分及睡眠质量评分均降低,且观察组低于对照组(P<0.05);两组均无显著不良反应。结论背根神经节脉冲射频术联合椎间孔注射臭氧及复合液可快速缓解PHN,改善患者睡眠质量。     

Oestrogen increases nociception through ERK activation in the trigeminal ganglion: evidence for a peripheral mechanism of allodynia

The mitogen-activated protein kinase, extracellular signal-regulated kinase (ERK), is activated in experimental models of chronic pain, and is also activated by oestrogen. We used an established model of inflammatory trigeminal pain, injection of Complete Freund's Adjuvant (CFA) into the masseter muscle, to determine whether ERK activation may play a role in hormone-related trigeminal pain disorders. We measured withdrawal responses to stimulation of the masseter (V3, primary allodynia) and whisker pad (V2, secondary allodynia) using graded monofilaments. Oestrogen treatment in the presence of inflammation increased withdrawal response to stimulation of both masseter and whisker pad compared with inflammation alone, indicating an additive effect of inflammation and oestrogen on both primary and secondary allodynia. We examined ERK activation in trigeminal ganglia from each treatment group using western blot and immunohistochemistry. Both masseter inflammation and oestrogen treatment increased ERK activation, and combined treatment had an additive effect. Both masseter inflammation and oestrogen increased the percentage of pERK immunoreactive neurons in divisions 1 and 2 (V1/2), and combined treatment increased pERK immunoreactivity in V1/2 compared with inflammation alone. We stereotactically administered ERK antagonist U0126, or inactive control U0124, to the trigeminal ganglion of CFA+E2-treated rats. U0126 decreased withdrawal responses to mechanical stimulation of the whisker pad compared with U0124-treated rats. Because the secondary allodynia in V2 after inflammation in V3 was reduced by antagonizing ERK activation in the periphery, these data suggest a peripheral component to secondary allodynia mediated through ERK activation.     

McGill疼痛问卷在三叉神经痛诊断和治疗中的应用

目的:通过采用McGill疼痛问卷(McGill pain questionnaire,MPQ)鉴别三叉神经痛,并观察射频热凝术的疗效,研究MPQ在面痛诊断上的重要性。方法:本研究共观察159例三叉神经痛患者,其中136例患有典型三叉神经痛(CTN),23例患有混合型三叉神经痛(MTN)。采用MPQ评估患者的疼痛,并观察其中124例术后患者疼痛的缓解情况。结果:CTN组的平均现有疼痛强度(PPI)值为4.20±0.34,MTN组的平均PPI值为3.50±0.57,明显低于CTN组(P0.001);与MTN患者相比,CTN患者在疼痛分级指数(PRI)-感觉项上报告了更高的强度(P0.001);两组间PRI-情感和PRI-评价项上有明显区别,CTN组的得分更高(P0.001);RFT术后CTN患者显示了高的立即疼痛缓解率,达到93.6%。MTN患者的结果没有CTN组的好,只有58.8%的患者疼痛明显缓解。结论:MPQ可以很好鉴别不同类型的三叉神经痛,鉴于射频热凝治疗两种三叉神经痛疗效的差异,使用MPQ在面痛诊断中有重要意义。     

Sphenopalatine ganglion block for treatment of sinus arrest in postherpetic neuralgia

A 64-year-old woman presented with bradycardia from sinus pauses during exacerbations of postherpetic trigeminal distribution neuralgia. She had underlying systemic lupus erythematosus. Sphenopalatine ganglion blockade was employed to treat her pain. The episodes of bradycardia resolved with successful alleviation of pain. This report emphasizes that a sphenopalatine ganglion blockade can be employed in the treatment and prevention of sinus arrest associated with postherpetic trigeminal distribution neuralgia.     

误诊为原发典型三叉神经痛的桥小脑角胆脂瘤的临床研究

目的：探讨三叉神经痛型桥小脑角胆脂瘤的发生机制、临床表现和治疗原则。方法：回顾性总结21例以原发典型三叉神经痛为主要表现的胆脂瘤患者的临床表现、肿瘤生长部位与大小、手术入路与技巧、结果和术后并发症等资料。结果：肿瘤全切16例,次全切5例。所有患者均表现为同侧三叉神经痛。术中发现10例肿瘤将三叉神经包绕在瘤内。术后三叉神经痛均消失,面部感觉减退2例,听力减退1例;1例疑似无菌性脑膜炎。结论：桥小脑角区胆脂瘤与三叉神经痛的关系复杂,应采取手术治疗,术中根据肿瘤和周围结构的关系以确定是否全切,术后注意无菌性脑膜炎等并发症。     

螺旋CT引导半月节脉冲射频治疗三又神经痛的远期疗效观察

目的 观察螺旋CT引导下半月节穿刺脉冲射频治疗三叉神经痛的远期疗效.方法 100例原发性三叉神经痛患者分为研究组(脉冲射频组,n=44)和对照组(射频热凝组,n=56).比较治疗前,治疗后0.5年、1年、2年时的疼痛数字模拟评分(NRS)及临床疗效.结果 治疗后1年内两组NRS无显著性差异,但2年后研究组复发率明显高于对照组(P＜0.01).结论 半月节脉冲射频治疗三叉神经痛安全有效,但远期疗效欠佳.     

Subclinical sensory abnormalities in trigeminal neuralgia

Trigeminal neuralgia is considered as a paroxysmal single nerve phenomenon. Abnormal sensory perception has been previously described in 15-25% of patients with clinical examination. Quantitative sensory testing (QST) was used to evaluate sensory perception in patients with idiopathic trigeminal neuralgia (ITN). Nine patients and 10 normal control subjects were evaluated in all six trigeminal branches. QST abnormalities were found in the symptomatic division and in the other two branches on the same side. Minor contralateral changes were also found. Differences consisted of cold and warm hypoaesthesia and higher cold and heat pain thresholds in patients. All differences proved statistically significant. Our findings suggest that trigeminal neuralgia is not only a paroxysmal single nerve disorder, but also that other higher structures may be involved.     

Radiofrequency and Pulsed Radiofrequency Treatment of Chronic Pain Syndromes: The Available Evidence

There are currently 6 reviews on (pulsed) radiofrequency (RF) for the management of spinal pain. Two reviews on interventional pain management techniques in general also discuss RF. The outcomes of those reviews depend on the type of studies included and the opinion of the reviewers, which may result in different evidence levels. Radiofrequency denervation at the cervical and lumbar level has produced the most solid evidence. The differences in treatment outcome registered in the 5 randomized controlled trials (RCTs) regarding lumbar facet denervation can be attributed to differences in patient selection and/or inappropriate technique. There is not sufficient evidence supporting the use of RF facet denervation for the management of cervicogenic headache. The studies examining the management of cervical radicular pain suggest a comparable efficacy for RF and pulsed RF (PRF). The PRF treatment is supposed to be safer and therefore should be preferred. The superiority of RF treatment adjacent to the lumbar dorsal root ganglion for the management of lumbar radicular pain has not been demonstrated in an RCT. Information regarding RF treatment of sacroiliac joint pain is accumulating. No randomized sham‐controlled trials on the value of RF treatment of the Gasserian ganglion for the management of idiopathic trigeminal neuralgia have been published. One RCT indicates superiority of RF over PRF for the management of idiopathic trigeminal neuralgia. Future research to confirm or deny the efficacy of (P)RF should be conducted in carefully selected patient populations. The tests used for patient inclusion in such a trial could potentially help the clinician in selecting patients for this type of treatment. The value of PRF treatment of the peripheral nerves also needs to be confirmed in well‐designed trials.     

三叉神经带状疱疹的护理

目的探讨对累及口腔的三叉神经带状疱疹患者的护理干预。方法13例三叉神经带状疱疹患者,口腔受累,有疱疹和糜烂,给予全身抗病毒治疗以及面部、口腔皮损局部用药。护理重点在预防疱疹破溃后继发感染,并注重口腔糜烂的护理、神经痛处理以及用药监护等。结果治疗、护理10天后患者面部及口腔水疱干燥、结痂,口腔糜烂逐渐愈合,20天后所有患者基本痊愈或痊愈,无严重并发症。结论防止面部、口腔疱疹继发感染是本病的护理重点,对口腔糜烂、疼痛等护理也是不可忽视的方面。