目的:观察和分析CT引导下选择性三叉神经单次脉冲射频治疗头面部带状疱疹后神经痛(pos-therpetic neuralgia, PHN)的临床效果。方法:36例头面部PHN住院病人随机分为2组:神经阻滞治疗组(A组);脉冲射频治疗组(B组)。A组在给予加巴喷丁治疗的基础上,根据受累三叉神经分支相应实施眶上、上颌、下颌神经及局部痛域皮下阻滞治疗;B组在给予加巴喷丁治疗的基础上,根据受累三叉神经分支相应实施CT引导下眶上神经、上颌神经和下颌神经脉冲射频治疗。治疗前及疗程完成后第3天、3月和12月进行疼痛程度评估。结果:各组疗程完成后第3天视觉模拟评分法(visual analogue scale, VAS)评分均较治疗前减低(P <0.05)。疗程完成后3月和12月各组治疗显效率均达60%以上,A组和B组显效率比较无统计学差异(P> 0.05)。各例治疗过程中均无严重并发症发生。结论:CT引导下选择性三叉神经单次脉冲射频是治疗头面部PHN安全而有效的方法,但临床效果不优于神经阻滞治疗。
Objective: To observe and analyze the clinical effects of CT-guided selective trigeminal single pulsed radiofrequency in treating postherpetic neuralgia(PHN) of the scalp and face. Methods: Thirty-six patients with PHN of the scalp and face who were hospitalized in our department were randomly divided into two groups: Group A-nerve block treatment group, Group B-pulsed radiofrequency(PRF) treatment group. In group A, on the basis of gabapentin treatment, according to the affected trigeminal nerve branches, the supraorbital,maxillary and mandibular nerves, and local pain subcutaneous blocks were applied. In group B, on the basis of gabapentin treatment, according to the involvement of the trigeminal nerve branches, CT-guided PRF treatment of the supraorbital, maxillary and mandibular nerves were applied. Pain severity was assessed before treatment and 3 days, 3 months and 12 months after the treatment. Results: The VAS scores on the 3 rd day after treatment in both groups decreased signi?cantly compared with the scores before treatment(P < 0.05).The treatment ef?-ciency in both groups exceeded 60% 3 and 12 months after the treatment, but there was no signi?cant difference between Group A and Group B(P > 0.05). No serious complications occurred in each group. Conclusion: CT-guided selective single PRF of trigeminal nerve is a safe and effective clinical method for the management of PHN of the scalp and face;but its ef?cacy is not superior to the effect of nerve block.
Chinese Journal of Pain Medicine