三叉神经痛患者经皮球囊压迫术治疗无效的影响因素分析

Analysis of factors contributing to the ineffectiveness of percutaneous balloon compression in patients with trigeminal neuralgia

摘要:

目的 探讨三叉神经痛患者经皮球囊压迫术治疗无效的影响因素。方法 回顾性分析2021年11月—2023年2月泰州市中医院收治的三叉神经痛患者89例的临床资料，所有研究对象采用经皮球囊压迫术治疗。根据球囊头球比将球囊分为A型（< 10%）、B型（10%～20%）、C型（> 20%），分别有27、39、23例。根据三叉神经痛患者经皮球囊压迫术后治疗效果分为有效组与无效组，分别有66、23例。对比两组术中球囊容积、球囊头球比及临床资料，分析三叉神经痛患者经皮球囊压迫术治疗无效的影响因素。结果 无效组球囊容积、B型球囊头球比均低于有效组（P <0.05）。无效组体质量指数≥ 24kg/m²比例高于有效组（P <0.05），卵圆孔长径短于有效组（P <0.05），卵圆孔低于有效组（P <0.05）。两组患者性别、年龄、高血压、饮酒史、病程、侧别、糖尿病、累及分支、卵圆孔横泾和横径比、吸烟史、外展神经麻痹、术后面部麻木比较，差异均无统计学意义（P >0.05）。多因素一般Logistic回归分析结果显示：球囊容积［O^R =0.265（95% CI：0.117，0.603）］、球囊头球比［O^R =0.242（95% CI：0.106，0.551）］、体质量指数高［O^R =3.062（95% CI：1.346，6.965）］、卵圆孔长径［O^R =0.215（95% CI：0.095，0.490）］为三叉神经痛患者经皮球囊压迫术治疗无效的影响因素（P <0.05）。结论 术中球囊容积、球囊头球比、体质量指数、卵圆孔长径与三叉神经痛患者经皮球囊压迫术治疗效果密切相关，且球囊容积较低、球囊头球比为A或C型、体质量指数高、卵圆孔长径短者治疗无效风险更高。

Abstract:

Objective To analyze the factors contributing to the ineffectiveness of percutaneous balloon compression in patients with trigeminal neuralgia.Methods A retrospective analysis was conducted on the clinical data of 89 patients with trigeminal neuralgia admitted to the Taizhou Hospital of Traditional Chinese Medicine between November 2021 and February 2023. All participants underwent percutaneous balloon compression therapy. Based on the head-to-body ratio of the balloons, they were divided into type C (n = 23, > 20%), type B (n = 39, 10%~20%) and type A (n = 27, < 10%). The patients with trigeminal neuralgia were categorized into the effective group and the ineffective group according to the effect of percutaneous balloon compression, with 66 and 23 cases in each group, respectively. The intraoperative balloon volumes, balloon head-to-body ratios, and clinical data of the two groups were compared. The factors associated with treatment failure in patients with trigeminal neuralgia undergoing percutaneous balloon compression were analyzed.Results The balloon volumes and the head-to-body ratios of the type B balloons in the ineffective group were lower than those in the effective group (P < 0.05). The proportion of patients with body mass index (BMI) ≥ 24kg/m² in the ineffective group was higher than that in the effective group (P < 0.05). The long diameter and the long diameter ratio of the foramen ovale in the ineffective group were lower than those in the effective group (P < 0.05). There was no statistically significant difference between the two groups in terms of sex, age, history of hypertension, history of alcohol consumption, disease duration, affected side, history of diabetes mellitus, involved branches, transverse diameter and transverse diameter ratio of the foramen ovale, smoking history, abducens nerve palsy, or postoperative facial numbness. Multivariable Logistic regression analysis showed that the balloon volumes [O^R = 0.265 (95% CI: 0.117, 0.603) ], balloon head-to-body ratios [O^R = 0.242 (95% CI: 0.106, 0.551) ], BMI [O^R = 3.062 (95% CI: 1.346, 6.965) ] and the long diameter of the foramen ovale [O^R = 0.215 (95% CI: 0.095, 0.490) ] were factors contributing to the ineffectiveness of percutaneous balloon compression in patients with trigeminal neuralgia (P < 0.05).Conclusion Intraoperative balloon volumes, balloon head-to-body ratios, BMI, and the long diameter of the foramen ovale are closely related to the therapeutic effect of percutaneous balloon compression in patients with trigeminal neuralgia. Lower balloon volumes, type A or C balloons, higher BMI, and reduced long diameter of the foramen ovale are associated with an increased risk of treatment ineffectiveness.