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沈阳专治脸三叉神经痛的方法 ppt课件

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沈阳专治脸三叉神经痛的方法 沈阳三叉神经痛 三叉神经痛沈阳方法 三叉神经痛沈阳办法 三叉神经痛的
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With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 沈阳专治脸三叉神经痛的方法 北京嘉泽东博医院 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society n三叉神经痛是一种临床较常见的、最顽固的、最 痛苦的疼痛性疾病有 些人患病数十年不得治愈。 严重影响患者的生活和劳动。患者可在内科、外 科等多个科室求治。本病诊断较容易,但治疗困 难,是多学科临床研究的热点疾病 n1.概念 n三叉神经痛是在面部三叉神经分布区内短 暂的、反复发作的阵发性剧痛。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 三叉神经分布区 图示 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 三叉神经分布说明 n三叉神经为混合性神经,含有躯体感觉和特殊内脏运动两 种纤维。特殊内脏运动纤维始于三叉神经运动核,组成三 叉神经运动根,经卵圆孔出颅,分布于咀嚼肌,它支配咀嚼 运动,躯体感觉纤维的胞体位于三叉神经节(半月神经节 )内。该节位于颞骨岩部尖端的三叉神经节压迹处,为两 层硬脑膜所包裹;由假单极神经元组成,其中枢突聚集成 粗大的三叉神经感觉根,由脑桥与脑桥臂交界处入脑,止 于三叉神经脑桥核和三叉神经脊束核;其周围突组成三叉 神经三条大的分支,称为眼神经、上颌神经和下颌神经, 分别支配眼裂以上、眼裂和口裂之间、口裂以下的感觉和 咀嚼肌收缩。三叉神经损害后可出现面部感觉和咀嚼运动 的障碍。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 三叉三叉NN 运动核运动核 三叉三叉NN 运动根运动根 半月半月NN节节 三叉三叉NN 脑桥核脑桥核 脊束核脊束核 眼神经眼神经 上颌上颌NN 下颌下颌NN 咀嚼肌咀嚼肌 特殊内特殊内 脏运动脏运动 躯体躯体 感觉感觉 三三 叉叉 NN 三叉神经分布图三叉神经分布图 www.sancha120.cn With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 2.分类: n从病因学的角度可分为: n原发性三叉神经痛 n症状性三叉神经痛 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 3.病因 n原发性三叉神经痛的病因不清.几种学说: n(1)血管压迫学说: n(2)机械压迫学说 n(3)缺血学说 n (4)中枢病源学说 n(5)其他: With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society ▄血管压迫学说 n目前最为流行并被许多学者公认的观点。 n①微血管压迫神经根 n1934年,Dandy首次提出血管压迫神经根是致痛的原因之 一,但未提及减压问题。 n1959年,Gardner首先报道1例神经血管减压术成功。 n1967年,Jannetta证实了Dandy关于血管压迫是引起三叉神 经痛的病因,并开创了显微血管减压术。 n1980年,Jannetta 在411例三叉神经痛手术中发现动脉、静 脉或动、静脉混合压迫三叉神经高达95%;Zorman 报道 125例三叉神经痛患者,术中见90例(72%)神经根部有血 管压迫。见图。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 血管血管 三叉神经三叉神经 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society ②颈内动脉压迫 : Kerr提出颈内动脉 管的骨顶部常可缺如由筋膜组织替代 ,故半月节腹面根及其分支与下面的 颈内动脉紧密接触,颈动脉的搏动使 半月节及后根髓鞘崩解而引起疼痛。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society ▄机械压迫学说 硬膜鞘或岩骨嵴的压迫:三叉神经节及后根 受包裹它的硬膜鞘及岩上窦的压迫或后根 通过硬膜孔时在高起的岩骨嵴处成角扭曲 受压而致病 .有人检查了130例三叉神经痛患 者的两侧岩骨嵴高度,在岩骨嵴稍高的一 侧发病率高3倍。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society ▄缺血学说 见于中老年人,易合并有动脉粥样硬化及 脑缺血缺氧,反复发作 ,血循环阻断后产生的 致痛物质而致三叉神经痛。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society ▄中枢病源学说 Wilson(1954)认为本病是一种位 于中枢的三叉神经元阵发性发放,类 似于感觉性癫痫。有人认为部位可能 在三叉神经脊束核内。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 5.临床特征 (1)发病情况:发病率1.8‰,多发生于中老年人,70-80% 病例发生于40岁以上,女性多于男性,为男性的2~3倍。 大多为单侧,以三叉神经第2、第3支发生率最高 .三叉神 经痛的发作常无预兆,疼痛历时数秒至数分钟。突发突止 ,间歇期正常。重者发作时在床上翻滚,并有自杀念头。 每次发作时间由几秒钟到几分钟不等。在夜间发作减轻或 停止。一般神经系统检查无阳性体征。性质:电击样 刀 割样 撕裂样或灼烧样剧痛。板机点:病人面、颌、舌部 受机械性刺激,如说话、进食、洗脸、刷牙、剃须甚至微 风拂面皆可诱发疼痛发作。 (2)痛性抽搐:严重时可伴同侧面部肌肉反射性抽搐,面 部潮红,眼结膜充血,流泪或流涎。 (3)病程: www.sancha120.cn With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 6.诊断 n三叉神经痛的主要诊断要点如下: 1.发痛部位为三叉神经或其某分支的分布区。 2.多为突然发作的阵发性剧痛,不发作时绝大部分 患者完全不痛,仅极少数患者仍有轻度疼痛。 3.大多数患者有“扳机点”,即触发点,刺激这些点 可引起疼痛发作,但发作刚过去,再刺激“扳机点”则不引 起发作。 4.95%以上的三叉神经痛患者为一侧性。 5.疼痛发作时不合并有恶心、呕吐。 6.对此病一般镇痛药物完全无效, 7.病程冗长 n With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 7.鉴别诊断n牙痛 n舌咽神经痛 n颞颌关节病 n非典型性面痛 n鼻窦炎 nMS,延髓空洞症,原发性/转移性颅底肿 瘤. n蝶腭神经痛 www.sancha120.cn With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 8.治疗 n病因治疗:继发性三叉神经痛 n症状治疗: n药物治疗:不建议使用 n无痛介入疗法:(专家首推疗法) With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society 药物治疗: 因三叉神经痛类似于癫痫样电发放,故临床上用抗癫痫药物来治 疗三叉神经痛 .常用的药物为卡马西平 卡马西平 :开始每次100 mg,tid可逐渐加量至每次200 mg。一般每 日600 mg可止痛或疼痛明显减轻。如效果不佳可逐渐增至最大剂量400 mg,每日2~4次,疼痛消失1~2周左右可逐渐减量、停药。主要不良 反应为服药期间出现头痛、头晕、发困等,偶有过敏疹者。较严重的 有复视,骨髓抑制,肝肾损害,血尿素氮偏高,抑郁症等。发生此类 严重反应者极少,且为时甚短,往往和剂量有关,一旦停药便可恢复 。在用药期间应检查血象(包括血小板和网织细胞)及肝、肾功能。 With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society n无痛介入疗法: n疗法介绍: n在影像可视系统引导下,利用美国进口高频热凝治疗技术 到达神经根部,精确定位病变神经并进行治疗,是目前国 际先进的治疗技术,治疗过程没有任何疼痛感。 n治疗原理 n利用治疗设备尖端特制的传感器,在影像系统引导下,到 达神经的根部,精确定位病变神经,通过特定电极传感器 精确输出超高频微波,选择性把神经传导痛觉纤维蛋白凝 固变性,而不影响正常神经感觉和温度觉的功能,是目前 最先进的治疗方法。 www.sancha120.cn With the improving quality of life as well as the ever-accelerating pace of life, the quality of people's food needs and rate also changing.In order to meet the needs of society END! 谢谢大家!
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