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| 3D打印导航模板在圆孔外口三叉神经第二支射频治疗中的应用 |
| Application of 3D printing navigational template in puncturing of foramen rotundum for radiofrequency thermocoagulation to treat primary trigeminal neuralgia (V2) |
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| DOI： |
| 中文关键词: 三叉神经痛 3D打印 三维重建 计算机辅助设计 圆孔 |
| 英文关键词: Trigeminal neuralgia 3D printing 3D reconstruction Computer aided design Foramen rotundum |
| 基金项目:南京市医学科技发展项目(ZKX15015) |
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| 中文摘要: |
| 目的 评估3D打印导航模板在圆孔入路三叉神经第二支射频热凝治疗中的有效性和准确性。方法 选择原发性三叉神经第二支疼痛患者43例,男27例,女16例,年龄45～85岁,ASA Ⅰ或Ⅱ级,按照随机数字表法分为观察组(A组,n=21)和对照组(B组,n=22)。所有患者术前均行头颅CT三维重建,模拟穿刺并确定最佳穿刺方案。A组采用3D打印导板辅助经皮穿刺,B组在CT引导下常规穿刺,术中均经3D-CT影像及电刺激试验确认针尖位置后再行射频热凝治疗。记录患者一次穿刺成功例数、术中CT扫描次数、术中CT辐射量、手术时间、术后即刻疼痛NRS评分以及感觉减退、面部肿胀、角膜反射减弱、脑脊液漏等并发症发生情况。结果 A组一次性穿刺成功率明显高于B组(90.4％ vs. 22.7％),CT扫描次数明显少于B组［(1.1±0.3)次 vs. (2.8±1.3)次］,CT辐射量明显小于B组［(323.1±108.7)mGy*cm vs. (787.8±355.7)mGy*cm］,手术时间明显短于B组［(15.3±5.5)min vs. (28.5±6.5)min］(P<0.05)。与术前比较,术后两组患者NRS评分明显降低［A组:(3.1±1.7)分 vs. (8.5±0.7)分;B组:(3.1±1.5)分 vs. (8.5±0.7)分］(P<0.05);两组患者NRS评分组间差异无统计学意义。所有患者均未发生严重并发症。结论 在充分术前路径规划的基础上,3D打印导航模板能够明显提高圆孔穿刺精准性、安全性,提高三叉神经第二支射频治疗的效率与质量。 |
| 英文摘要: |
| Objective To explore the effectiveness and precision of 3D printing navigational template in puncturing of foramen rotundum for radiofrequency thermocoagulation to treat primary trigeminal neuralgia (V2). Methods Forty-three patients (27 males, 16 females, aged 45-85 years, ASA grade Ⅰ or Ⅱ) with primary trigeminal neuralgia (V2) were included and randomly divided into experimental group (group A, n=21) and control group (group B, n=22). After taking a CT scan and 3D reconstruction of each patient’s skull, puncture simulations were carried out, then the final puncture schemes were decided. In group A, puncture was performed under guidance of navigational template but was conducted empirically in group B. In both groups, 3D-CT image and electrical stimulation were used in all the procedures to confirm the location of point of needle before radiofrequency thermocoagulation. The cases of successful puncture in one time, times of CT scanning, radiant quantity, operation time during the operation in both groups were recorded. Furthermore, NRS scores and complications including hypoesthesia, motor function degeneration, hematoma, absence of corneal reflex, cerebrospinal fluid leakage were recorded after procedure. Results The rate of successful puncture in one-time of group A was superior than that of group B (90.4％ vs. 22.7％). Compared with group B, CT scan times ［(1.1±0.3) times vs. (2.8±1.3) times］, radiant quantity ［(323.1±108.7) mGy*cm vs. (787.8±355.7) mGy*cm］, operation time ［(15.3±5.5) min vs. (28.5±6.5) min］ in group A were significantly reduced (P<0.05). NRS scores of both two groups were obviously reduced after surgery ［group A: (3.1±1.7) scores vs. (8.5±0.7) scores; group B: (3.1±1.5)scores vs. (8.5±0.7) scores］ (P<0.05), but the effectiveness in group A was not superior than group B. No serious complications occurred in all patients. Conclusion On the basis of sufficient preoperative planning of puncture approach, 3D printing template can significantly enhance the effectiveness and precision of puncture of foramen rotundum, improving the efficiency and quality of radiofrequency treatment of primary trigeminal neuralgia (V2). |
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