Tian Yunhu, Liu Ya, Liu Huancai
Department of Orthopaedics, the Affiliated Hospital of Weifang Medical College, Weifang Shandong 261031.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2007 Sep;21(9):967-9.
To investigate the effect of neurolysis on intractable greater occipital nerve neuralgia.
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.
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.
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.
探讨神经松解术治疗顽固性枕大神经痛的效果。
1998年3月至2005年8月，对26例顽固性枕大神经痛患者进行治疗。其中男性12例，女性14例，平均年龄52岁（38 - 63岁）。病程3 - 7年。16例有长期低头工作史，5例外伤后出现症状，其余病因不明。视觉模拟评分（VAS）为6.0至9.5，平均8.6。7例在全身麻醉下行下斜肌切断术，19例在局部麻醉下行枕大神经松解术。检查压迫肿物。
术后26例症状立即改善或消失。伤口一期愈合。切除肿物的病理结果包括淋巴结（3例）、神经鞘瘤（2例）和瘢痕（5例）。术后3天26例VAS评分为0至5（平均2分）。23例随访1至3年。术后1个月23例VAS评分为0至4.5（平均1.9分）。仅2例复发，症状改善。6例劳累后疼痛加重，口服消炎镇痛药后缓解。其余未复发。
彻底松解枕大神经（包括下斜肌切断、帽状腱膜与半棘肌间松解），使枕大神经无任何压迫，是治疗顽固性枕大神经痛的关键。
