射频热凝和脉冲射频治疗三叉神经痛的疗效和安全性评价

Comparison between Radiofrequency Thermocoagulation and Pulsed Radiofrequency for the Treatment of Trigeminal Neuralgia

摘要:

目的：对比射频热凝和脉冲射频治疗三叉神经痛的疗效和安全性。方法：回顾性分析393例2010至2017年就诊于我院疼痛科行射频热凝术（n=300）和脉冲射频术（n=93）的三叉神经痛患者。按照射频热凝术：脉冲射频术=2:1的匹配比例进行匹配，匹配后射频热凝术治疗组为186例，脉冲射频术治疗组为93例。初始疼痛缓解率定义为术后1个月内的疼痛缓解。收集疼痛复发时间。复发标准定义为BNI疼痛评分IV和V分。此外，还需收集记录术后1个月，两种射频治疗技术的并发症情况及治疗满意度情况。结果：射频热凝术组和脉冲射频术组患者初始疼痛缓解率分别为100.0%和71.0%（P< 0.001）。射频热凝术2年有效率为89.8%。脉冲射频术2年有效率为48.4%。生存分析结果显示，射频热凝手术的镇痛维持时间明显优于脉冲射频（P < 0.0001），脉冲射频术治疗相对于射频热凝术治疗的复发风险比为3.718，95%可信区间为1.779 - 7.772。结论：射频热凝术在2年内的疗效明显优于脉冲射频术，但不可避免的带来神经损毁后并发症。尽管疗效不及射频热凝术，但接受脉冲射频术的患者的术后1月治疗满意度与射频热凝术相当。

Abstract:

Objective: This study aimed to compare the efficacy and safety of radiofrequency thermocoagulation and pulsed radiofrequency for the treatment of trigeminal neuralgia. Methods: We retrospectivly analyzed the patients with trigeminal neuralgia who were admitted to the department of pain of Beijing Tiantan Hospital and received radiofrequency thermalcoagulation (n=300) or pulsed radiofrequency (n=93) from 2010 to 2017. According to the matching ratio of radiofrequency thermocoagulation: pulsed radiofrequency =2:1, 186 patients in the radiofrequency thermocoagulation group and 93 patients in the pulsed radiofrequency group were matched after propensity score matching. The initial pain relief rate was defined as pain relief within 1 month postoperatively. Recurrence time of pain was collected. Recurrence criteria were defined as IV and V of BNI pain scores. In addition, side effects and patients’ treatment satisfaction were also recorded 1 month after surgery. Results: Initial pain relief rates of patients in the radiofrequency thermocoagulation group and pulsed radiofrequency group were 100.0% and 71.0%, respectively, and the difference between the two groups was statistically significant (P < 0.001). In the radiofrequency thermocoagulation group, the effective rate was 89.8% at 2 years. In the pulsed radiofrequency group, the effective rate was 48.4% at 2 years. Survival analysis showed that the effectiveness of radiofrequency thermocoagulation significantly outperformed pulsed radiofrequency (hazard ratio = 3.718, 95% confidence interval 1.779-7.772, P < 0.0001). Conclusion: Radiofrequency thermocoagulation is more effective than pulsed radiofrequency in 2 years, but it inevitably has side effects after nerve damage. Although less effective than radiofrequency thermocoagulation in general, patients treated with pulsed radiofrequency had similar satisfaction with radiofrequency thermocoagulation 1 month postoperatively.