经皮穿刺微球囊压迫术与显微血管减压术治疗三叉神经痛的疗效对比及预后影响因素分析

Comparison of clinical efficacy of percutaneous microballoon compression and microvascular decompression in the treatment of trigeminal neuralgia and construction of prognostic nomogram for PMC

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月至2025年9月我院收治的135例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 校正二元Logistic回归分析PMC预后影响因素，基于独立影响因素构建探索性nomogram列线图并验证。结果 PMC组总缓解率90.00%（63/70），MVD组90.77%（59/65），两组比较差异无统计学意义（P>0.05）；PMC组并发症总发生率高于MVD组，但以暂时性并发症为主，手术时间及住院天数均更短（P<0.05）。Firth校正多因素Logistic回归显示：球囊容积≥0.6 mL、压迫时间≥110 s、球囊呈梨形/类梨形是PMC术后预后良好的独立影响因素（P均< 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 TN 近期疗效与 MVD 相当，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，本研究构建的列线图可为临床个体化预后评估提供参考。

Abstract:

Objective To compare the clinical outcomes of C-armassisted percutaneous microballoon compression (PMC) and microvascular decompression (MVD) in patients with trigeminal neuralgia (TN), and to explore the prognostic factors of PMC.Methods A retrospective analysis was performed on 135 patients with TN treated in our hospital from January 2020 to September 2025, including 70 patients in the PMC group and 65 in the MVD group. Clinical efficacy, complications, operation duration, and length of hospital stay were compared between the two groups. Firth-corrected binary logistic regression was applied to identify independent prognostic factors for PMC due to rare adverse outcomes and imbalanced data. An exploratory prognostic nomogram was developed and internally validated.Results The total pain remission rate was 90.00% (63/70) in the PMC group and 90.77% (59/65) in the MVD group, with no significant difference between the two groups(χ2=0.058,P=0.809). The overall complication rate was significantly higher in the PMC group [30.00% (21/70)] than in the MVD group [12.31% (8/65)] (χ2=5.872,P=0.015), but most complications in the PMC group were transient, mainly including facial numbness [22.86% (16/70)] and masticatory weakness [10.00% (7/70)], while complications in the MVD group were mainly hearing impairment [4.62% (3/65)] and cerebrospinal fluid leakage [3.08% (2/65)]. Operation duration and length of hospital stay in the PMC group were significantly shorter than those in the MVD group [(30.24±7.13) min vs. (113.58±21.41) min, t=-29.882, P<0.001; (5.83±1.14) d vs. (12.46±2.85) d, t=-17.500, P<0.001]. Firth-corrected multivariate logistic regression demonstrated that balloon volume ≥0.6 mL (OR=5.87,95%CI:1.92~17.93,P=0.002), compression time ≥110 s (OR=4.21,95%CI:1.35~13.14,P=0.013), and pear-shaped/pear-like balloon morphology ((OR=8.24,95%CI:2.11~32.96,P=0.002)) were independent favorable prognostic factors for PMC. The nomogram showed satisfactory discrimination (AUC=0.85,95%CI:0.79~0.91) and calibration (Hosmer-Lemeshow test, P=0.623) in internal validation.Conclusion C-arm-assisted PMC achieves comparable short-term efficacy to MVD for TN, with the advantages of minimal invasiveness, rapid procedure, and fast recovery, rendering it more suitable for primary hospitals, elderly patients, and those with poor surgical tolerance. Balloon volume, compression time, and balloon morphology are key prognostic determinants of PMC. The exploratory nomogram established in this study may provide a reliable reference for individualized clinical assessment.