C臂引导下高电压长时程脉冲射频治疗疱疹后三叉神经第Ⅰ支慢性疼痛的疗效与安全性分析

Efficacy and safety of high-voltage, long-duration pulsed radiofrequency therapy for the post-herpetic branch I-trigeminal chronic neuralgia guided by C-arm

摘要:

目的 探讨半月神经节高电压长时程脉冲射频术治疗疱疹后三叉神经第Ⅰ支慢性疼痛方法的安全性及效果。方法 回顾性选取云南省第一人民医院疼痛科2020年1月至2022年9月期间收治的疱疹后第Ⅰ支三叉神经痛患者，共纳入63例患者，男25例，女38例，年龄62.64±11.27岁。根据所接受的治疗将患者分为两组：脉冲组（对照组，n=30）与高电压组（实验组，n=33）。C臂引导下经皮穿刺达卵圆孔内1/3处，连接射频温控热凝仪及相配套的电极，行感觉、运动测试确定为第Ⅰ支三叉神经支配区域，进行脉冲射频（42 ℃，360 s，45 V）或高电压长时程射频（42 ℃，900 s，40-100 V，逐渐升压，直到患者不能耐受为止），在不同时间点视觉模拟评分（NRS）和36条目简明健康量表（SF-36）评估治疗效果，出院患者则使用电话随访，同时评估临床治疗有效率和术后并发症。结果 两组患者术前基本资料均无显著差异。脉冲组与高电压组治疗前NRS评分分别为（7.6±0.89）、（7.58±0.83）分，无统计学差异（P＞0.05）。术后3天、3月、6月和12月时，脉冲组NRS评分分别为（6.1±1.06）、（5.3±0.95）、（4.63±0.85）和（4.8±0.89）分，而高电压组分别为（4.73±1.15）、（3.61±1.27）、（3.36±1.45）和（3.7±1.24）分。术后两组NRS评分及口服普瑞巴林剂量均呈下降趋势，而SF-36则呈现上升趋势，各时间点与术前均存在统计学差异（P＜0.0001），除术后第12月药物剂量外同一时间点高电压组结果均显著优于脉冲组（P＜0.0001）。术后12月时高电压组患者临床有效率（69.7%）显著高于脉冲组（36.7%）（P=0.0004）。脉冲组不良反应发生率为16.7%，高电压组不良反应发生率为15.2%，差异无统计学意义（P＞0.9999）。结论 C臂引导下三叉神经半月节脉冲射频和高电压长时程射频治疗均可以明显缓解疱疹后三叉神经第Ⅰ支疼痛并降低普瑞巴林剂量，同时提高患者生活质量，且后者效果更优，两种射频方式均无明显并发症。

Abstract:

Objective To investigate the safety and efficacy of high-voltage, long-duration pulsed radiofrequency in the treatment of the branch I-trigeminal neuralgia. Method A total of 63 patients（25 males and 38 females, aged 62.64±11.27 years）with post-herpetic branch I-trigeminal neuralgia admitted to the Department of Pain Medicine of Yunnan First People's Hospital from January 2020 to September 2022 were retrospectively selected. Patients were divided into two groups based on the treatment: pulse group (control group, n=30) and high-voltage group (experimental group, n=33). Guided by the C-arm, percutaneous puncture was performed at 1/3 of the inner foramen ovalis. The radiofrequency thermocoagulation instrument and the accompanying electrode were connected. Sensory and motor tests were performed to determine the area innervated by the trigeminal nerve of Branch I. Pulse radiofrequency (42 ℃, 360 s, 45 V) or high voltage long-term radiofrequency (42 ℃, 900 s, 40-100 V, were performed, and the voltage was gradually increased. Until the patient can no longer tolerate it). The visual analogue Scale (NRS) and the 36-item Concise Health Scale (SF-36) were evaluated at different time points to assess the efficacy, patients discharged from hospital were followed up by telephone, as well as the clinical effective rate and postoperative complications. Result There was no significant difference in preoperative baseline data between the two groups. NRS scores in the pulse group and the high-voltage group before treatment were (7.6 ± 0.89) and (7.58 ± 0.83), respectively, with no statistical significance (P＞0.05). At 3 days, 3 months, 6 months and 12 months, NRS scores in the pulse group were (6.1 ± 1.06), (5.3 ± 0.95), (4.63 ± 0.85) and （4.8±0.89） respectively, while those in the high-voltage group were (4.73 ± 1.15), (3.61 ± 1.27), (3.36 ± 1.45) and （3.7±1.24）respectively. The NRS score and oral pregabalin dose of the two groups showed a downward trend, while the SF-36 showed an upward trend, and there were statistical differences at each time point compared with preoperation (P<0.0001), and the results of the high-voltage group were significantly better than those of the pulse group at the same post-operative time point except for the drug dose in the 12th month after surgery (P<0.0001). 12 months after operation, the clinical effective rate of high-voltage group (69.7%) was significantly higher than that of pulse group (23.3%) (P = 0.0004). The incidence of adverse reactions was 16.7% in the pulse group and 15.2% in the high voltage group, the difference was not statistically significant (P＞0.9999). Conclusion Under the guidance of C-arm, both pulse radiofrequency therapy and high-voltage, long-duration radiofrequency therapy could safely and effectively relieve the pain of post-herpetic branch I-trigeminal neuralgia and reduce the dose of pregabalin, while improving the quality of life of patients, and the latter effect is better, and there are no obvious complications in both radiofrequency modalities. 【Keywords】Postherpetic Branch I-trigeminal neuralgia; High-voltage, long-duration radiofrequency; Pulsed radiofrequency; Numerical Rating Scale; 36-Item short health scale