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山东大学学报 (医学版) ›› 2024, Vol. 62 ›› Issue (5): 95-102.doi: 10.6040/j.issn.1671-7554.0.2024.0193

• 临床医学 • 上一篇    

CT重建下经侧入路卵圆孔穿刺入路建立及其应用

梁原浩1,肖文珊2,彭盛昕3,张翼翔1,师彬4,于功昌4,刘垒5   

  1. 1.山东第二医科大学中医学院, 山东 潍坊 261053;2.山东第一医科大学运动医学与康复学院, 山东 泰安 271016;3.滨州医学院康复医学院, 山东 滨州 256603;4.山东第一医科大学附属颈肩腰腿痛医院疼痛科, 山东 济南 250014;5.山东第一医科大学第一附属医院疼痛科, 山东 济南 250014
  • 发布日期:2024-05-29
  • 通讯作者: 刘垒. E-mail:fort0825@sina. com
  • 基金资助:
    2020年山东省体医融合项目培育库试点项目(62);2021年度山东第一医科大学校级教育教学改革研究课题(2021XY08);山东省重点研发计划(2022CXGX020510);齐鲁医派中医学术流派传承项目(鲁卫函［2022］93号);2020年度齐鲁卫生与健康领军人才培育工程项目(鲁卫人才字［2020］3号);2024第一批山东省体卫融合示范项目(鲁体办字［2023］28号)

Establishment and application of three-dimensional computed tomography reconstruction-guided percutaneous lateral approach for foramen ovale puncture

LIANG Yuanhao1, XIAO Wenshan2, PENG Shengxin3, ZHANG Yixiang1, SHI Bin4, YU Gongchang4, LIU Lei5   

  1. 1. College of Traditional Chinese Medicine, Shangdong Second Medical University, Weifang 261053, Shandong, China;
    2. College of Sports Medicine and Rehabilitation, Shandong First Medical University, Taian 271016, Shandong, China;
    3. College of Rehabilitation Medicine, Binzhou Medical University, Binzhou 256603, Shandong, China;
    4. Department of Pain Treatment, Neck-Shoulder and Lumbocrural Pain Hospital of Shandong First Medical University, Jinan 250014, Shandong, China;
    5. Department of Pain Treatment, The First Affiliated Hospital of Shandong First Medical University, Jinan 250014, Shandong, China
  • Published:2024-05-29

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摘要： 目的 探讨三维CT引导下以经皮颧弓下紧贴下颌骨的乙状切迹上缘为皮肤穿刺点,经侧入路的卵圆孔穿刺方法,为选择性射频热凝半月神经节治疗三叉神经痛,提供一种新的可行性治疗途径。 方法 取已锯开顶骨的成年人颅骨标本3具,用22G射频穿刺针分别模拟Hartel前入路及侧入路穿刺,针尖均进入卵圆孔内,应用CT对带有穿刺针的颅骨标本进行扫描,建立卵圆孔穿刺的CT下标准影像。依据CT重建的图像数据,对两种不同路径的穿刺针体、针尖位置关系进行测量、分析,获得侧入路穿刺到达半月神经节靶点的规律和技巧。同时选取2022年3月至2023年2月山东第一医科大学第一附属医院疼痛科收治行侧入路穿刺进入卵圆孔,对半月神经节进行温控射频热凝治疗的64例原发性2、3支三叉神经痛患者临床资料进行回顾性分析,观察疗效及感觉减退情况。 结果 通过穿刺针和颅骨标本配合,经由CT扫描及重建图像,对比两种穿刺路径,指导CT引导下经皮侧入路卵圆孔穿刺技术的建立。对64例原发性三叉神经第2、3支疼痛患者应用该技术进行穿刺,均可成功进入卵圆孔,实现了对半月神经节选择性的射频热凝治疗。术后随访1周至12个月,平均(6.0±1.9)个月,患者疗效满意且无复发。 结论 CT引导下经皮颧弓下紧贴下颌骨的乙状切迹上缘为皮肤穿刺点,侧入路卵圆孔穿刺技术,为选择性射频热凝半月神经节治疗三叉神经痛提供一种疗效确切、可行的、值得临床推广的治疗途径。

关键词: 三叉神经痛, 射频, 三维CT重建, 卵圆孔, 侧入路, 颅骨标本

Abstract: Objective To investigate three-dimensional computed tomography(CT)-guided percutaneous lateral approach for foramen ovale puncture and introduce a novel method for treating trigeminal neuralgia through selective radiofrequency thermocoagulation. Methods Three adult skull specimens with sawn parietal bones were scanned using a 22 G radiofrequency puncture needle. The Hartel anterior and lateral approaches for puncture were simulated. The needle tips were inserted into the foramen ovale, followed by skull CT scan with the puncture needles in place. The specimens were scanned to establish a standard image for CT perforations. Using the CT reconstruction data, the relationship between the needle positions and tips for the two pathways was measured and analyzed. This analysis helped determine the techniques and skills required for the lateral approach puncture to accurately target the semilunar ganglion. Additionally, the clinical data of 64 patients with primary trigeminal neuralgia types 2 and 3, who were treated with radiofrequency thermocoagulation in the Gasserian ganglion from March 2022 to February 2023, were retrospectively analyzed to assess treatment efficacy and sensory loss. Results Using the needle and skull specimen, complemented by CT scan and image reconstruction, two puncture pathways were compared. The CT-guided percutaneous lateral approach facilitated the successful establishment of a foramen ovale perforation, which was applied to treat 64 patients with primary trigeminal neuralgia, achieving successful entry into the foramen ovale and enabling selective ganglion radiofrequency thermocoagulation. The patients were followed for 1 week to 12 months, with an average of(6.0±1.9)months, and reported treatment satisfaction and no recurrence. Conclusion The application of CT-guided percutaneous lateral perforation technique provides a new and feasible therapeutic approach for treating trigeminal neuralgia by selective radiofrequency thermocoagulation of the semilunar ganglion.

Key words: Trigeminal neuralgia, Radio frequency, 3D-CT reconstruction, Ovarian foramen, Lateral approach, Skull specimens

中图分类号: 

  • R651.1
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