本文選題：下頜角 + 卵圓孔�。� 參考：《浙江大學》2015年碩士論文

【摘要】：目的 原發(fā)性三叉神經痛(Trigeminal neuralgia, TN)好發(fā)于中老年人群,疼痛劇烈且頑固,口服卡馬西平有效但易復發(fā)。國內外比較公認原發(fā)性三叉神經痛是由于三叉神經感覺根入髓區(qū)(Root entry zone, REZ)存在血管壓迫和脫髓鞘改變,微血管減壓術效果滿意。但對于部分心肺功能較差或其他臟器功能不全的的患者開顱手術風險較大,以及術后復發(fā)的患者再次開顱手術的依從性欠佳,對于此類患者經皮卵圓孔穿刺半月神經節(jié)射頻術是較理想的治療手段。射頻熱凝治療TN一般采用Hartel前入路卵圓孔穿刺法,入顱后結合電生理測試尋找射頻治療的靶點,文獻報道存在4%的穿刺失敗率且術中常伴隨一定的神經血管損傷的并發(fā)癥,遠期存在一定的復發(fā)率。為進一步降低風險并提高治療效果,本研究采用經皮下頜角入路顱底卵圓孔穿刺選擇性半月神經節(jié)內靶點射頻術治療原發(fā)性三叉神經痛并評價其療效和安全性。方法 選擇原發(fā)性三叉神經痛患者60例,疼痛視覺模擬評分(Visual analogue scale, VAS)大于或等于8分。采用隨機數字表法將患者隨機分為2組,H組(n=30)以Hartel前入路法進行顱底卵圓孔穿刺；G組(n=30)以患側下頜角為穿刺點進行顱底卵圓孔穿刺,兩組以同樣的參數進行半月神經節(jié)內靶點測試和射頻熱凝。比較兩組穿刺成功率和相關并發(fā)癥發(fā)生率,記錄術后Id、7d、1m、6m、12m、24m,36月VAS評分和巴羅神經學研究所疼痛分級(BNI pain score)評估比較兩組鎮(zhèn)痛治療效果。 結果 H組穿刺的成功率為96.7%,G組為93.3%(P0.05),H組穿刺時出現血腫3例,G組血腫1例(P0.05)；H組射頻熱凝累及正常三叉神經分支11例(36.7%),三叉神經運動纖維損傷8例(26.7%)；G組無一例累及正常三叉神經分支,三叉神經運動纖維損傷3例(10%),兩組比較具有顯著性差異(P0.05)。H組各時點有效率為96.7%、96.7%、96.7%、93.3%、83.3%、73.3%、70%,G組各時點有效率為96.7%、96.7%、96.7%、96.7%、96.7%、93.3%、86.7%；兩組術后12月,24月和36月的有效率比較具有顯著性差異(P0.05) 結論 經皮下頜角入路卵圓孔穿刺半月神經節(jié)射頻熱凝術治療原發(fā)性三叉神經痛具有穿刺徑路合理、并發(fā)癥少、更高的靶點選擇性和更低的遠期疼痛復發(fā)率等優(yōu)勢。
[Abstract]:Purpose Primary trigeminal neuralgia (TNN) occurs in the middle and elderly population. The pain is severe and stubborn. The oral administration of carbamazepine is effective but easy to relapse. It is generally acknowledged that primary trigeminal neuralgia is due to the presence of vascular compression and demyelinating changes in the sensory root of trigeminal nerve into the medullary area. The effect of microvascular decompression is satisfactory. But for some patients with poor cardiopulmonary function or other organ dysfunction, the risk of craniotomy was higher, and the compliance of patients with recurrent craniotomy was poor. For these patients, percutaneous foramen ovale puncture semilunar ganglion radiofrequency is an ideal treatment. Radiofrequency thermocoagulation (RFA) is commonly used in the treatment of TN by Hartel anterior approach foramen ovale puncture, posterior craniotomy combined with electrophysiological test to find the target of radiofrequency therapy. It is reported that there are 4% failure rate of puncture and some complications associated with nerve and vascular injury during the operation. There is a long-term recurrence rate. In order to further reduce the risk and improve the therapeutic effect, this study was conducted to evaluate the efficacy and safety of selective radiofrequency radiofrequency in the treatment of primary trigeminal neuralgia by percutaneous mandibular angle approach with selective puncturing the foramen ovale of the skull base. Method Visual analogue scale (vas) score of 60 patients with primary trigeminal neuralgia was greater than or equal to 8 points. The patients were randomly divided into 2 groups by random digital table. The patients were treated with Hartel's anterior approach to puncture the foramen ovale of the base of the skull. Group G was punctured with the mandibular angle of the affected side as the puncture point, and the foramen ovale of the base of the skull was punctured with the anterior approach of Hartel. The same parameters were used to measure the targets in the meniscus ganglion and radiofrequency thermocoagulation. The success rate of puncture and the incidence of related complications were compared between the two groups. The analgesic effect of the two groups was evaluated by VAS score at 36 months and the pain score by Barrow Institute of Neurology (BNI pain scorere). Result The success rate of puncture in group H was 96.7%. In group G, there were 3 hematoma in group G and 3 cases in group H. 1 case of hematoma in group G involved normal trigeminal nerve branch with radiofrequency thermocoagulation, 11 cases with normal trigeminal nerve branch, and 8 cases with motor fiber injury of trigeminal nerve in group G without involvement of normal trigeminal nerve branch. There were significant differences between the two groups in the effective rate of 96.77.796.79.70.The effective rate of each time point in group H was 96.77.79.79.76.70.The effective rate of the two groups was 96.796. 796. 796. 790. 7796. 7796. 7796. 7796. 7790. 790. 7790. 790. 790. 7 and 96.7. the effective rates of the two groups were 96.796. 796. 793. 3 and 86. 7 respectively. The effective rates of 24 months and 36 months after operation were significantly higher in the two groups than in the other two groups (P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05, P 0. 05). Conclusion Radiofrequency thermocoagulation for the treatment of primary trigeminal neuralgia by percutaneous foramen ovale puncture has the advantages of reasonable puncture route, less complications, higher target selectivity and lower long-term pain recurrence rate.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R614

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