CT引导下手动调节面神经射频热凝术治疗面肌痉挛的疗效观察

Effect of CT guided manual adjustment of facial nerve radiofrequency thermocoagulation in hemifacial spasm

摘要:

目 的 观察CT引导下手动调节面神经射频热凝术治疗面肌痉挛的疗效。方 法 选择自2020年1月1日至2022年10月1收治于延边大学附属医院(延边医院)疼痛科的面肌痉挛患者28例,其中男10例,女16例,年龄54~73岁,病程3个月~20年。患者取侧卧位在CT引导下,选择乳突前入路持射频套管针穿刺,以2mm层厚扫描直至确认针尖到达茎乳孔外口处,即面神经干走形处,行感觉测试(50Hz、0.6mA)可诱发出患侧面部疼痛,行运动测试(2Hz、0.6mA)直至出现患侧面部肌肉节律性抽动,插入射频针芯,连接匹配电极,以每10S上升1℃手动调节射频温度直至患者出现鼓腮轻度漏气,该温度为最终射频温度,治疗结束。观察患者治疗前、治疗后第1d、7d、1月、3月、6月的面肌痉挛评分、焦虑自评量表(self- rating anxiety scale,SAS)评分、抑郁量表(self-rating depression scale,SDS)评分；记录患者行运动测试可诱发出患侧面部肌肉跳动的最小电压及出现鼓腮轻度漏气时的射频温度(即最终射频温度)；记录治疗后1 d的面瘫评分及治疗后3月、6月的复发率。记录穿刺失败例数及血肿、感染、听力障碍等并发症发生情况。结 果 与治疗前相比,治疗后第1d、7d、1月、3月、6月的面肌痉挛评分、SAS、SDS评分降低,P＜0.05,差异有统计学意义；患者行运动测试引出患侧面部肌肉节律性跳动的最小电压 0.310±0.124 V；最终射频温度为64.46±6.90 ℃,治疗后1 d的面瘫评分为1.56±0.57分。所有患者无穿刺失败、均未出现血肿、感染、听力障碍等并发症。治疗后3月、6月无复发。结 论 CT引导下手动调节面神经射频热凝术治疗面肌痉挛安全有效,同时可改善患者焦虑、抑郁状态。最终射频温度为64.46±6.90℃,术后可出现轻度面瘫。

Abstract:

Objective To observe the effect of CT-guided facial nerve in for facial spasm. Methods 28 patients with facial spasm were admitted to the Pain Department of Yanbian University (Yanbian Hospital) from January 1,2020 to January 1,2022, including 10 male and 16 female, aged 54 to 73 years old, and the course of disease was 3 months to 20 years. In the lateral position, select the puncture, scan with 2mm thickness until the tip reached the mouth of the orifice of the facial nerve, sensory test (50Hz, 0.6mA) can induce the pain of the affected side, exercise test (2Hz, 0.6mA) until the affected side muscle rhythmic pumping, inserted the RF core, connect the matching electrode, manually adjust the RF temperature by 1℃ every 10S until the patient has a mild gas leak, the temperature is the final RF temperature, and the treatment is over. Observe the facial spasm score, anxiety score, self-rating anxiety scale, SAS), depression scale (self-rating depression scale, SDS); record the minimum voltage of the lateral muscle beating and the mild air leak (i. e. final RF temperature); record the facial paralysis score 1d after treatment and the recurrence rate at 3 months and June after treatment. The number of puncture failures and the occurrence of complications such as hematoma, infection and hearing impairment were recorded. Results: 1d, 7d, January, March, SAS, SDS score decreased, P <0.05; the minimum voltage was 0.310 ± 0.124 V; the final RF temperature was 64.466 ± 6.90℃, and the facial paralysis score at 1 d after treatment was 1.56 ± 0.57. All patients had no puncture failure, and no complications such as hematoma, infection, or hearing impairment. There was no recurrence at 3 months and 6 months after treatment. Conclusion Manual adjustment of facial nerve is safe and effective to treating facial spasm and can improve anxiety and depression. The final RF temperature was 64.46 ± 6.90℃, and mild facial paralysis may occur after surgery.