神经肌电图检查对周围性面瘫预后评估价值及其与House-Brackman分级的相关性研究

Prognostic value of neuroelectromyography in peripheral facial paralysis and its correlation with House-Brackman classification

目的探讨神经肌电图检查对周围性面瘫患者预后评估价值及其与House-Brackman(H-B)分级的相关性。方法选取义乌市中心医院2016年1月至2019年1月就诊的周围性面瘫患者78例作为研究对象,均进行神经肌电图检查,分析并记录患者双侧神经传导速度(NCV)、潜伏期、波幅和口轮匝肌肌群、眼轮匝肌群和额肌群的针电极电图情况,治疗后随访3个月,分析患者预后情况及其与H-B分级的相关性。结果78例患者肌电图检查显示:潜伏期长68例,且患侧(3.78±0.33)ms,明显长于健侧(2.89±0.35)ms;M波幅下降73例,患侧(0.60±0.27)mV,明显低于健侧(1.83±0.29)mV;均差异有统计学意义(t=15.256、26.522,均P<0.001)。78例患者肌电图检查中,正常2例,异常76例,异常率为97.44%;其中,静息状态下出现正锐、纤颤波等自发电位46例,轻收缩时出现运动单位动作电位时限长、多相波比40例,重收缩时出现募集电位异常52例。随访3个月后,H-B分级与预后:轻度患者25例,完全恢复者23例,治愈率为92.00%(23/25);中度患者36例,完全恢复者28例,治愈率为77.78%(28/36);轻中度患者10例,完全恢复者7例,治愈率为70.00%(7/10);重度患者5例,完全恢复者3例,治愈率为60.00%(3/5)。结论神经肌电图检测可以提高诊断周围性面瘫损伤程度的准确性,与H-B分级有很强的相关性,可以对诊疗提供参考。

Objective To investigate the prognostic value of neuroelectromyography in peripheral facial paralysis and its correlation with House-Brackman classification.Methods Seventy-eight patients with peripheral facial paralysis who received treatment in Yiwu Central Hospital,China between January 2016 and January 2019 were included in this study.All patients underwent neuroelectromyography.Bilateral nerve conduction velocity,latency,amplitude,and the needle electrode electrogram of orbicularis oris muscles,rbicularis oculi muscles and frontal muscles were analyzed and recorded.After 3 months of treatment,the correlation between prognosis and House-Brackman classification was analyzed.Results Electromyography examination of 78 patients revealed among 68 patients presenting with prolonged latency,the latency on the affected side was significantly longer than that on the healthy side[(3.78±0.33)ms vs.(2.89±0.35)ms],t=15.256,P<0.001].Among 73 patients presenting with decreased M amplitude,M amplitude on the affected side was significantly lower than that on the healthy side[(0.60±0.27)mV vs.(1.83±0.29)mV,t=26.522,P<0.001].Among 78 patients,normal electromyography findings were observed in 2 patients and abnormal findings in 76 patients,with an abnormal rate of 97.44%.Among 78 patients,46 patients presented with fibrillation potentials and positive sharp waves in the resting state,40 patients presented with long duration and multiphase wave percentage of motor unit action potential in mild contraction,and 52 patients presented with abnormal recruitment potential in severe contraction.Three months of follow-up revealed that 23 out of 25 patients with mild peripheral facial paralysis had a complete recovery,with the cure rate of 92.00%(23/25),28 out of 36 patients with moderate peripheral facial paralysis had a complete recovery,with the cure rate of 77.78%(28/36),7 out of 10 patients with mild and moderate peripheral facial paralysis had a complete recovery,with the cure rate of 70.00%(7/10),and 3 out of 5 patients with severe peripheral facial paralysis had a complete recovery,with the cure rate of 60.00%(3/5).Conclusion Neuroelectromyography can improve the accuracy in the identification of injury degree of peripheral facial paralysis and has a strong correlation with House-Brackman classification.Therefore,neuroelectromyography can provide a reference for diagnosis and treatment of peripheral facial paralysis.