三叉神经半月神经节球囊压迫与射频热凝治疗原发性三叉神经痛临床疗效比较

Comparison of clinical efficacy between percutaneous balloon compression and radiofrequency thermocoagulation of the trigeminal ganglion for primary trigeminal neuralgia

摘要:

目的：比较DSA引导下经皮穿刺三叉神经半月神经节球囊压迫术 (percutaneous balloon compression, PBC) 与射频热凝术 (percutaneous radiofrequency thermocoagulation, PRT) 治疗原发性三叉神经痛 (primary trigeminal neuralgia, PTN) 的临床疗效及安全性。方法：回顾性分析2022年6月至2025年12月于联勤保障部队第九四〇医院介入疼痛科住院治疗的PTN患者的临床资料及随访资料，共纳入127例。根据手术方式不同分为两组：PBC组（62例）和PRT组（65例）。比较两组患者术后3个月和6个月时的治疗有效率，术前、出院时及出院后1、3、6个月的疼痛数字评定量表 (numerical rating scale, NRS) 评分变化，术后平均住院天数，术后外周神经阻滞治疗次数，以及术后并发症及不良反应发生情况。结果：两组患者术前一般资料及NRS评分比较差异无统计学意义。主要结局指标方面，术后3个月及6个月随访时，两组治疗有效率差异均无统计学意义。与术前相比，两组患者术后各时间点NRS评分均显著降低 (P < 0.01) 。出院时，PBC组NRS评分显著低于PRT组 (P < 0.01)，但出院后1、3、6个月时两组NRS评分差异无统计学意义。PBC组术后平均住院天数短于PRT组 (P < 0.05)，术后接受外周神经阻滞治疗次数亦少于PRT组 (P < 0.01)。并发症方面，PBC组术后即刻面部麻木发生率高于PRT组 (P < 0.05)，但术后1个月及3个月随访时两组差异无统计学意义；术后咀嚼肌无力发生率两组差异无统计学意义，且均在随访期内明显恢复。结论：PBC与PRT治疗原发性三叉神经痛均安全有效，短期疗效相当。与PRT相比，PBC在术后早期疼痛控制、缩短住院时间及减少额外医疗干预方面更具优势，尽管术后即刻面部麻木发生率较高，但多为可逆性，不影响远期恢复。临床可根据患者具体情况个体化选择手术方式。

Abstract:

Abstract Objective: To compare the clinical efficacy and safety of digital subtraction angiography (DSA) guided percutaneous balloon compression (PBC) versus percutaneous radiofrequency thermocoagulation (PRT) of the trigeminal ganglion in the treatment of primary trigeminal neuralgia (PTN). Methods: A retrospective analysis was conducted on clinical and follow-up data of patients with PTN who were hospitalized in the Department of Interventional Pain Therapy, The 940th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from June 2022 to December 2025. A total of 127 patients were enrolled and divided into two groups according to the surgical procedure: PBC group n=62 and PRT group n=65. The following parameters were compared between the two groups: treatment response rates at 3 and 6 months post-discharge; changes in Numerical Rating Scale (NRS) scores before surgery, at discharge, and at 1, 3, and 6 months after discharge; mean postoperative hospital stay; frequency of peripheral nerve block therapy after surgery; and incidence of postoperative complications and adverse reactions. Results: No statistically significant differences were found in baseline clinical data or preoperative NRS scores between the two groups. Regarding the primary outcome, there was no significant difference in treatment response rates between the two groups at 3 and 6 months of follow-up. Compared with preoperative values, NRS scores at all postoperative time points were significantly decreased in both groups (P < 0.01). At discharge, the NRS score in the PBC group was significantly lower than that in the PRT group (P < 0.01); however, no significant differences were observed between the two groups at 1, 3, and 6 months after discharge. The PBC group had a significantly shorter mean postoperative hospital stay (P < 0.05) and required fewer peripheral nerve block treatments after surgery compared with the PRT group (P < 0.01). In terms of complications, the incidence of immediate postoperative facial numbness was significantly higher in the PBC group than in the PRT group (P < 0.05); however, this difference was no longer significant at 1 and 3 months of follow-up. There was no significant difference in the incidence of postoperative masticatory muscle weakness between the two groups, and all complications showed marked recovery during the follow-up period. Conclusion: Both PBC and PRT are safe and effective minimally invasive treatments for PTN, achieving comparable short-term efficacy. Compared with PRT, PBC offers advantages in early postoperative pain control, shorter hospital stay, and reduced need for additional medical interventions. Although PBC is associated with a higher incidence of immediate postoperative facial numbness, this effect is predominantly reversible and does not compromise long-term recovery. The choice of surgical procedure should be individualized based on patient-specific conditions.