短时程周围神经电刺激与脉冲射频治疗带状疱疹相关三叉神经痛的疗效对比研究

Comparative Efficacy of Short-term Peripheral Nerve Stimulation and Pulsed Radiofrequency in Treating Herpes Zoster-associated Trigeminal Neuralgia

摘要:

目的：回顾性分析并对比短时程周围神经电刺激（short term peripheral nerve stimulation, st-PNS）与脉冲射频（pulsed radiofrequency, PRF）治疗带状疱疹相关三叉神经痛的临床疗效。方法：收集2021年8月1日至2024年6月30日就诊于山东第一医科大学附属省立医院疼痛科，诊断为带状疱疹相关三叉神经痛的81例患者为研究对象，按治疗方式分为st-PNS组（46例）和PRF组（35例）。根据治疗靶点分为半月神经节亚组（37例，其中GGS 15例，GG-PRF 22例）和眶上神经亚组（44例，其中SNS 31例，SN-PRF 13例）。记录其术前、出院时、术后1、3、6、12个月的数字评定量表评分（numerical rating scale, NRS）、医院焦虑抑郁量表评分（hospital anxiety and depression scale, HADS）、匹兹堡睡眠质量指数（Pittsburgh sleep quality index, PSQI）、生活质量评定量表评分（36-item short-form survey, SF-36）以及不良反应发生情况等资料进行对比分析。结果：两种疗法均能有效缓解疼痛并改善睡眠、情绪及生活质量。st-PNS在整体上展现出优于PRF的疗效，且该优势可持续至术后12个月。亚组分析显示，眶上神经（supraorbital nerve, SN）靶点的SNS组早期即显现全面疗效优势，且持续至术后12个月；半月神经节靶点的GGS和GG-PRF早期疗效相当，远期疗效GGS组更优。多因素分析显示，病程（OR=0.940，P=0.046）和治疗方式（OR=0.059，P=0.002）是疗效的独立影响因素。眶上神经靶点中，SNS疗效显著优于SN-PRF（OR=0.022，P=0.002）；半月神经节靶点（37例）中，GGS与GG-PRF短期疗效无统计学差异，但长期随访GGS在多维度改善方面更具优势（需进一步验证）。结论：st-PNS和PRF均可安全有效地治疗带状疱疹相关三叉神经痛，但st-PNS比PRF更具临床优势：针对眶上神经靶点，其疗效优势于治疗早期即可全面显现；针对半月神经节靶点，其优势则主要体现在远期综合改善效果（需进一步验证）。

Abstract:

Objective: To retrospectively analyze and compare the clinical efficacy of short-term peripheral nerve stimulation (st-PNS) and pulsed radiofrequency (PRF) in the treatment of herpes zoster-associated trigeminal neuralgia. Methods: A total of 81 patients diagnosed with herpes zoster-associated trigeminal neuralgia, who were treated in the Department of Pain Management, Shandong Provincial Hospital Affiliated to Shandong First Medical University between August 1, 2021, and June 30, 2024, were included. Based on the treatment modality, they were divided into a short-term peripheral nerve stimulation (st-PNS) group (n=46) and a pulsed radiofrequency (PRF) group (n=35). Further subgrouping according to the treatment target yielded a gasserian ganglion (GG) subgroup (n=37), consisting of a gasserian ganglion stimulation (GGS) group (n=15) and a gasserian ganglion pulsed radiofrequency (GG-PRF) group (n=22), as well as a supraorbital nerve (SN) subgroup (n=44), comprising a supraorbital nerve stimulation (SNS) group (n=31) and a supraorbital nerve pulsed radiofrequency (SN-PRF) group (n=13). Numerical Rating Scale (NRS) scores, Hospital Anxiety and Depression Scale (HADS) scores, Pittsburgh Sleep Quality Index (PSQI), and 36-Item Short-Form Health Survey (SF-36) scores were recorded preoperatively, at discharge, and at 1, 3, 6, and 12 months postoperatively, along with the occurrence of adverse events, for comparative analysis. Results: Both therapies effectively alleviated pain and improved sleep, mood, and quality of life. st-PNS demonstrated superior overall efficacy compared to PRF, and this advantage persisted up to 12 months postoperatively. For the trigeminal ganglion, early efficacy was comparable between GGS and GG-PRF, while GGS showed superior long-term outcomes (requiring further validation). Multivariate analysis identified disease duration (OR=0.940, P=0.046) and treatment modality (OR=0.059, P=0.002) as independent predictors. For the supraorbital nerve, SNS significantly outperformed SN-PRF (OR=0.022, P=0.002). In the trigeminal ganglion group (n=37), short-term efficacy was similar, but long-term follow-up suggested potential advantages of GGS in multidimensional improvement. Conclusion: While both st-PNS and PRF proved effective and safe, st-PNS offers distinct advantages. Notably, it confers early and comprehensive benefits at the supraorbital nerve, whereas at the gasserian ganglion, its superiority is characterized by sustained, comprehensive improvement over the long term (requiring further validation).