C型臂引导穿刺针位于卵圆孔内不同区域治疗三叉神经痛疗效观察

目的:探讨在C型臂引导下穿刺针位于卵圆孔内不同区域,行半月神经节周围注射阿霉素治疗三叉神经痛的临床疗效。方法:回顾性分析90例原发性三叉神经痛患者。在C型臂引导下,根据影像学将卵圆孔划分为内、中、外三个区域,按穿刺针位于卵圆孔内不同区域分为A、B、C三组,每组30例。A、B、C三组穿刺针分别位于卵圆孔内侧、中部、外侧区域。行卵圆孔半月神经节周围注射0.5%阿霉素0.5 ml。采用视觉模拟疼痛评分(visual analogue scale,VAS)作为疼痛水平评价指标,疼痛缓解度作为疗效评价标准。观察治疗前及治疗后当日、7天、14天、1月、6月、12月的临床疗效。结果:90例三叉神经痛患者均顺利完成卵圆孔穿刺和治疗。三组患者治疗前、治疗当日、治疗后7天、14天、1月、6月、12月VAS和有效缓解例数均未见统计学差异。与治疗前相比,三组治疗后当日、7天、14天、1月、6月和12个月VAS评分均降低(P<0.05)。12个月随访观察A组有效率为76.7%,B组有效率为76.7%,C组有效率为73.3%。治疗后无明显并发症。结论:在C型臂引导下,经皮穿刺卵圆孔行半月神经节周围注射0.5%阿霉素0.5 ml治疗三叉神经痛时,穿刺针位于卵圆孔内不同区域均有效且安全性较高。

THE EFFECTS OF INTERVENTIONAL TREATMENT WITH NEEDLE IN DIFFERENT REGIONS OF THE OVAL FORAMEN FOR TRIGEMINAL NEURALGIA GUIDED BY C-ARM

Objective: To observe the effects of interventional treatment with needle in different regions of the oval foramen guided by C-arm,with adriamycin injected around the semilunar ganglion for trigeminal neuralgia.Methods: 90 cases of primary trigeminal neuralgia were retrospectively analysed.Under the guidance of the C-arm and imaging analysis,the oval foramen was divided into inner,middle and outer zones.The patients were divided into A,B,C groups according to the location of needle in the oval foramen(n = 30).In the A,B,C groups,the needle were respectively located the medial,central and lateral zones.Adriamycin(0.5%,0.5 ml) was injected around semilunar ganglion.visual analogue score(VAS) was used to evaluate the pain level,and degree of pain relief was used to evaluate the clinical effects.The VAS and the clinical effects were evaluated at the day of treatment,7 d,14 d,1 m,6 m,12 m after treatment.Results: 90 cases were successfully completed with trigeminal neuralgia oval foramen puncture and treatment.The VAS and clinical effects showed no significant statistical difference among three groups before the treatment,at the day of treatment,and 7 d,14 d,1 m,6 m,12 m after treatment.Compared with before treatment,the VAS was decrease in three groups at the day of treatment,7 d,14 d,1 m,6 m,12 m after treatment.After 12 months follow-up,the effective rate was 76.7% in group A,76.7% in group B and 73.3% in group C.No significant complication was observed after treatment.Conclusion: Interventional treatment with needle in different regions of the oval foramen guided by C-arm,with adriamycin(0.5%,0.5 ml) injected around the semilunar ganglion can effectively treate trigeminal neuralgia.