【摘要】 目的探讨枕大神经松解术治疗顽固性枕大神经痛的疗效。方法1998年3月~2005年8月,收治26例保守治疗无效的顽固性枕大神经痛患者。男12例,女14例;年龄38~63岁,平均52岁。病程3~7年。16例有长期低头工作史,5例有外伤史,余无明显诱因。视觉模拟评分法(visual analogue scales,VAS)评分6.0~9.5分,平均8.6分。7例全麻下行头下斜肌切断松解枕大神经,19例局麻下行枕大神经松解。术中10例切除肿物并行病理检查。结果26例术后疼痛明显缓解或消失,切口均期愈合。病理检查:淋巴结3例,神经鞘瘤2例,瘢痕压迫5例。术后3dVAS评分为0~5分,平均2分。23例获随访1~3年。术后1个月VAS评分为0~4.5分,平均1.9分。其中2例复发,症状较术前减轻,未再行手术探查;6例劳累后疼痛略加重,口服消炎镇痛类药物或理疗后可缓解;余患者无复发。结论对枕大神经行彻底松解,包括头下斜肌的切断、斜方肌与头半棘肌间松解、浅出斜方肌与骨纤维管处松解,使其走行过程中无任何压迫,是治疗顽固性枕大神经痛的关键。更多还原

【Abstract】 Objective To investigate the effect of neurolysis on intractable greater occipital nerve neuralgia. Methods From March 1998 to August 2005, twenty-six patients suffering from intractable greater occipital nerve neuralgia were treated. There were 12 males and 14 females with an average age of 52 years(ranged 38-63 years). The disease course was 3-7 years. Sixteen cases had a long duration of work with bowing head, 5 cases symptoms appeared after trauma, and others had no identified causes. The visual analogue scales(VAS) scoring was 6.0 to 9.5, averaged 8.6. Seven cases were treated by apocope of obliquus capitis inferior under general anaesthesia and 19 cases were treated by neurolysis of greater occipital nerve under local anaesthesia. The compression mass were examined. Results Symptoms ameliorated or disappeared in 26 cases immediately after operation. The wounds healed by first intention. The pathological results of the removal mass included lymph node (3 cases), neurilemmoma (2 cases) and scar (5 cases). The VAS scoring of 26 cases was 0 to 5 ( average, 2) 3 days after operation. Twenty-three cases were followed up for 1 to 3 years. The VAS scoring of 23 cases was 0 to 4.5 ( average, 1.9) 1 months after operation. Only two cases recurred and the symptoms were ameliorated. Pain aggavated after tiredness and reliveed after oral anti-inflammatory analgesics in 6 cases. No relapse occurred in the others. Conclusion The complete neurolysis of greater occipital nerve (including apocope of obliquus capitis inferior, release between the cucullaris and semispinalis) which make the greater occipital nerve goes without any compression is the key point to treat intractable greater occipital nerve neuralgia.更多还原