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目的:对经侧方入路与经卵圆孔神经射频热凝术治疗原发性三叉神经下颌支顽固性疼痛进行临床比较。方法:2003年6月～2007年6月,68例原发性三叉神经下颌支顽固性疼痛患者被纳入,随机分成两组,分别在DSA介导下进行经侧方入路或经卵圆孔三叉神经下颌支射频热凝术。利用视觉模拟评分法(VAS)进行各自术前与术后不同时段疗效评定。利用Kaplan-Meier生存曲线与Log-Rank检验比较两组术后疗效,同时记录手术副作用、并发症发生情况及复发率,进行统计比较。结果:术后两组VAS评分均明显下降,术前术后比较差异有统计学意义(P<0.05)。两组患者术后疗效组间比较,差异无统计学意义(P>0.05)。副作用方面,两组患者术后均有一定程度的下颌支支配区域皮肤麻木,舌体侧方麻木,味觉减退,伸下颌协调性下降。并发症方面,经侧方入路组的患者术后没有严重并发症以及主观不适,经卵圆孔组出现3例神经损伤。发生率高于经侧方入路组(P<0.05)。两组术后复发率无显著差异。结论:经侧方入路与经卵圆孔下颌神经射频热凝术相比,两者均有定位确切、操作方便的特点,均有优良的临床疗效,但前者的手术并发症少于后者。
OBJECTIVE: To compare the clinical results of transforaminal and transforaminal radiofrequency thermocoagulation for the treatment of primary trigeminal mandibular intractable pain. Methods: From June 2003 to June 2007, 68 patients with primary trigeminal mandibular refractory and refractory pain were enrolled and randomly divided into two groups. The patients underwent DSA-mediated or transforaminal approach Trigeminal branch radiofrequency thermocoagulation. The visual analogue scale (VAS) was used to evaluate the curative effect at different preoperative and postoperative periods. The Kaplan-Meier survival curve and Log-Rank test were used to compare the curative effect of the two groups. At the same time, the side effects, complications and recurrence rate were recorded and compared statistically. Results: The postoperative VAS scores of both groups were significantly decreased, the difference was statistically significant before and after operation (P <0.05). There was no significant difference between the two groups in postoperative efficacy (P> 0.05). Side effects, the two groups of patients had a certain degree of postoperative limb mandibular branch numbness in the area, the lateral side of the tongue numbness, taste diminished, lower jaw coordination decreased. Complications, the lateral approach group of patients without serious complications and subjective discomfort, 3 cases of neuropathic pain in the foramen ovale group. The incidence was higher than that of the lateral approach group (P <0.05). There was no significant difference in the recurrence rate between the two groups. CONCLUSIONS: Compared with trans-maxillary radiofrequency thermocoagulation via transforaminal mandibular approach, both of them have excellent clinical curative effect with exact location and convenient operation. However, the former has less complications than the latter .