经皮穿刺微球囊压迫术治疗三叉神经痛的疗效及预后影响因素分析

Clinical efficacy of percutaneous microballoon compression in treatment of trigeminal neuralgia and influencing factors for prognosis

摘要:

目的 对比C臂辅助经皮穿刺微球囊压迫术（PMC）与显微血管减压术（MVD）治疗三叉神经痛（TN）的临床效果，并分析PMC的预后影响因素。方法 回顾性分析2020年1月—2025年9月江西省新余市人民医院收治的135例原发性TN患者临床资料，其中，PMC组70例，MVD组65例。比较两组的临床效果、并发症、手术时间及住院天数；采用Firth校正多因素Logistic回归分析PMC预后的影响因素，基于影响因素构建探索性列线图并验证。结果 PMC组并发症总发生率高于MVD组，以暂时性并发症为主，但手术时间及住院天数均更短（P<0.05）。球囊容积≥0.6 mL、压迫时间≥110 s、球囊呈梨形／类梨形是PMC预后良好的影响因素（均P<0.05）。基于此构建的列线图经内部验证具有良好区分度（AUC=0.85）与校准度（P=0.623）。结论 C臂辅助PMC治疗原发性TN的近期疗效与MVD相当，且具有微创、快速、恢复快的优势，更适合基层医院及高龄、耐受性差的患者。球囊容积、压迫时间、球囊形状是PMC预后关键因素，构建的列线图可为临床个体化预后评估提供参考。

Abstract:

Objective To investigate the clinical efficacy of C-arm-assisted percutaneous microballoon compression （PMC） versus microvascular decompression （MVD） in the treatment of patients with trigeminal neuralgia （TN）， as well as the influencing factors for the prognosis of PMC.Methods A retrospective analysis was performed for the clinical data of 135 patients with TN who were treated in Xinyu People's Hospital from January 2020 to September 2025， with 70 patients in the PMC group and 65 patients in the MVD group. The two groups were compared in terms of clinical outcome， complications， time of operation， and length of hospital stay. The Firth-corrected binary logistic regression analysis was used to identify the influencing factors for the prognosis of PMC， and an exploratory nomogram model was established based on these influencing factors and was then validated.Results Compared with the MVD group， the PMC group had a significantly higher overall complication rate （mainly transient complications） and significantly shorter time of operation and length of hospital stay （P<0.05）. Balloon volume ≥0.6 mL， compression time ≥110 s， and pear-shaped/pear-like balloon morphology were influencing factors for favorable prognosis after PMC （P<0.05）. Internal validation showed that the nomogram model established based on these factors had good discriminatory ability （AUC=0.85） and calibration （P=0.623）.Conclusions C-arm-assisted PMC achieves comparable short-term efficacy to MVD in the treatment of TN， with the advantages of minimal invasiveness， rapid procedure， and fast recovery， and therefore， it is more suitable for primary hospitals， elderly patients， and patients with poor surgical tolerance. Balloon volume， compression time， and balloon morphology are key factors for prognosis after PMC， and the nomogram model established in this study may provide a reference for individualized clinical assessment.