摘要
目的探讨副神经射频热凝术联合肉毒毒素肌内注射治疗旋转型痉挛性斜颈疗效。方法回顾南京大学医学院附属鼓楼医院疼痛科2017年1月至2021年12月收治的旋转型痉挛性斜颈患者60例,根据治疗方法不同分为联合治疗组(n=30)和肉毒毒素组(n=30)。联合治疗组给予副神经射频热凝术联合肉毒毒素痉挛肌内注射治疗;肉毒毒素组单纯给予痉挛肌内注射肉毒毒素治疗。于治疗后1及3个月时观察患者疼痛数字等级评分(NRS)、Tsui评分、患者健康问卷(PHQ-9)和焦虑自我评估量表(GAD-7)评分及美国简明健康量表(SF-36),记录症状缓解持续时间和治疗后不良反应。结果两组患者治疗前各指标差异无统计学意义,治疗后1个月时联合治疗组NRS与SF-36评分分别为(0.9±0.6)分和(90±7)分,治疗后1及3个月时Tsui评分分别为(3.2±1.8)分和(4.3±1.5)分,较肉毒毒素组有显著改善,差异均有统计学意义(P<0.05)。联合治疗组症状缓解持续时间(6.4±2.9)个月,肉毒毒素组为(4.5±2.3)个月,差异有统计学意义(P<0.05)。两组均出现3例颈部肌肉无力,肉毒毒素组1例出现吞咽乏力,均在治疗后7~15 d自行缓解。结论采用副神经射频热凝术联合肉毒毒素肌内注射治疗旋转型痉挛性斜颈患者,效果确切,症状缓解持续时间延长,并可减少肉毒毒素注射胸锁乳突肌内导致吞咽困难的不良反应。
Objective To investigate the effect of accessory nerve radiofrequency thermocoagulation combined with intramuscular botulinum toxin injection on patients with rotating spastic torticollis.Methods Sixty patients with rotating spasmodic torticollis in Department of Pain Medicine,Drum Tower Hospital,Affiliated Hospital of Nanjing University Medical School from January 2017 to December 2021 were reviewed.Patients were divided into two groups(30 cases in each group):the combination treatment group(accessory nerve radiofrequency thermocoagulation combined with intramuscular botulinum toxin injection)and the botulinum toxin group(intramuscular botulinum toxin injection only).NRS,Tsui,depression(PHQ-9),anxiety(GAD-7)and scores of life quality(SF-36)were observed at 1 and 3 months after the treatment.The duration of symptom relief and adverse reactions were recorded after treatment.Results There were no significant differences in basic characteristics between the two groups before the treatment.Compared with the botulinum toxin group,NRS and SF-36 at 1 month after the treatment were[(0.9±0.6)and(90±7)]scores,and Tsui scores at 1 month and 3 months were[(3.2±1.8)and(4.3±1.5)]scores after the treatment,which were all better improved(P<0.05).The duration of symptom relief was(6.4±2.9)months in the combination treatment group and(4.5±2.3)months in the botulinum toxin group.The duration of symptom relief was longer in the combination treatment group than botulinum toxin group(P<0.05).There were three cases of neck muscle weakness in each group,and 1 case with weak swallowing in the botulinum toxin group,after the treatment,and all were recovered 7 to 15 days after the treatment.Conclusion Accessory nerve radiofrequency thermocoagulation combined with intramuscular botulinum toxin injection is effective in the treatment of patient with rotating spasmodic torticollis,with longer response duration and less side-effects caused by excessive botulinum toxin injection.
作者
韩影
朱彤
王然
李静
林建
Han Ying;Zhu Tong;Wang Ran;Li Jing;Lin Jian(Department of Pain Management,Nanjing Drum Tower Hospital of the Affiliated Hospital of Nanjing University Medical School,Nanjing City,Jiangsu Province 210008,China)
出处
《中华疼痛学杂志》
2022年第3期325-330,共6页
Chinese Journal Of Painology
关键词
斜颈
痉挛性
副神经
射频热凝术
肉毒毒素
Torticollis,spasm
Accessory nerve
Radiofrequency thermocoagulation
Botulinum toxin
