目的 探讨通过3D-slicer处理后的三维时间飞跃法磁共振血管成像(3D-TOF-MRA)和三维稳态采集快速成像序列(3D-FIESTA)对三叉神经萎缩评估的作用.方法 搜集38例三叉神经痛患者(实验组)和38例面肌痉挛患者(对照组)纳入研究.所有患者均进行3D-TOF-MRA和3D-FIESTA序列检查,通过3D-slicer进行图像融合,比较两组双侧的三叉神经体积.结果 实验组患侧三叉神经体积(77.74±11.31)mm3小于实验组非患侧(78.42±14.43)mm3(P＜0.01)和对照组(80.23±23.31)mm3,95％CI:77.10～83.37 mm3(P＜0.01).实验组的三叉神经体积差异ΔV为(15.40±9.07)％大于对照组ΔV=(5.42％±3.20)％(P＜0.01).责任血管压迫TREZ、MC、JP不同部位的两侧三叉神经ΔV(17.86±11.28)％、(13.02±3.87)％、(7.73±4.72)％,差异有统计学意义(P=0.045);TREZ与JP ΔV差异明显,差异有统计学意义(P=0.006).对Ⅰ级压迫、Ⅱ级压迫、Ⅲ级压迫,ΔV分别为(7.33±5.09)％、(12.47±4.85)％、(25.12±9.85)％,差异有统计学意义(P＜0.01).且三叉神经萎缩程度与术后预后情况成正相关(OR=0.900,P＜0.05).结论 三叉神经萎缩与三叉神经痛有一定的相关性,其萎缩程度在三叉神经不同压迫部位及压迫程度中存在差异,且可考虑作为一个预测术后预后的观察指标.
目的:三维成像辅助下的微血管减压术与经皮微球囊压迫术在三叉神经痛治疗中的价值.方法:将2019年2月—2020年2月于河北省人民医院收治的76例三叉神经痛患者纳入研究,通过随机数字表法分为两组,每组38例.实验组行三维成像辅助下的微血管减压术治疗,对照组行球囊压迫术治疗.对比分析两组患者的即刻和远期疗效,并发症发生情况和成本效益.结果:两组术后即刻缓解率差异无统计学意义(P>0.05),但随时间延长两组在有效率上出现差异,且具有统计学意义(P<0.05).在并发症上,实验组较少出现面部麻木和口唇疱疹等情况,具有统计学差异(P<0.05).两组患者都出现了咬肌无力的情况,但两组之间并无统计学差异(P>0.05).在成本效益上,虽然实验组在疗效上高于对照组(P<0.05),但实验组花费同样也高于对照组(P<0.05).因此两组在成本效益上的差异并无统计学意义(P>0.05).结论:两组手术方式在短期内都能有效缓解疼痛,但是由于三维成像辅助下的微血管减压术长期有效率较高,并发症较少,且有更好的疗效,可作为大部分三叉神经痛患者首选的治疗方式.
Objective:To systemically evaluate the efficacy, safety and economy of microvascular decompression (MVD) and radiofrequency thermocoagulation (RFT) in the treatment of trigeminal neuralgia (TN).Methods:The literatures on MVD and RFT for treatment of TN were retrieved from PubMed, Embase, Cochrane Library, CNKI, Wanfang Medical Network, and the website of Weipu database. Randomized controlled trials of MVD and RFT for primary trigeminal neuralgia were collected at home and abroad, from January 1970 to July 10, 2017. The literatures were screened strictly according to the inclusion and exclusion criteria, and the Newcastle Ottawa Scale and the modified Jadad scale were used for quality assessment. Meta analysis was performed using Revman 5.3.Results:A total of 9 studies were eventually included. Meta analysis results showed that, compared with RFT, fewer patients with MVD needed secondary surgery [ OR=0.26, 95% CI (0.16-0.42), P<0.001], fewer patients experienced facial numbness [ OR=0.13, 95% CI (0.08-0.21), P<0.001], lower VAS [ MD=-2.07, 95% CI (-2.62 - -1.51), P<0.001], and fewer postoperative drug users [ OR=0.26, 95% CI (0.16-0.42), P<0.001]. However, more patients had postoperative complications [ OR=2.10, 95% CI (1.13-3.91), P=0.02] and more expensive treatment costs with MVD [ MD=37.19, 95% CI (19.90-54.47), P<0.001]. Conclusion:MVD is more effective in treating TN than RFT, but with more complications and higher treatment costs. RFT can be used as an alternative treatment.
目的 探讨显微血管减压术(microvascular decompression,MVD)治疗面肌痉挛术中应用同步视频监测侧方扩散反应(lateral spread response,LSR)的意义.方法 回顾性分析105例行MVD且术中实施同步视频LSR监测的面肌痉挛病人的临床资料.分别将依据术中LSR监测及同步视频LSR监测预测术后痉挛缓解情况的结果与术后临床观察结果进行比较,分析两种方法在术后预测痉挛缓解情况方面的优劣性.结果 经Kappa一致性检验分析:术中LSR监测与临床观察结果比较,在术后1周和1个月为中等一致(K1周 = 0.565,K1月 = 0.467),术后6个月一致性差(K= 0.326);同步视频LSR监测与临床观察结果比较,术后1周和1个月为中等一致(K1周 = 0.533,K1月= 0.580),术后6个月高度一致(K=0.753).比较术后6个月的预测结果,在敏感性及特异性方面,同步视频LSR监测优于LSR监测.105例术后1周、1个月、6个月痉挛缓解良好率分别为71.14％、81.90％、87.62％.结论 在MVD术中应用同步视频LSR监测对判断病人预后更有指导意义.
