原发性面肌痉挛联带运动的临床特征

Analysis of clinical characteristics of synkinesis in primary hemifacial spasm patients

目的探讨原发性面肌痉挛联带运动的临床特征。方法对212例原发性面肌痉挛患者的病史资料及临床录像资料进行整理,选择与联带运动相关的3个解剖部位(额部、眼部及口部),观察3个联带运动动作(眉弓抬高、眼裂缩小、口角牵动)及5个自主动作(抬眉、皱眉、闭眼、示齿及噘嘴),分析原发性面肌痉挛患者人口学特点、联带运动临床特点、联带运动严重程度及个数与面肌痉挛严重程度的相关性。结果原发性面肌痉挛患者发病年龄(56.07±12.40)岁,病程(54.90±59.96)个月。针对47例5个基本动作完备的原发性面肌痉挛患者进行联带运动类型相关分析,其中口-眼联带运动模式最常见[55.32%(26/47)],噘嘴是最容易引起联带运动的自主动作[55.32%(26/47),P<0.01],眼裂缩小是最常出现的联带运动动作[57.45%(27/20),P<0.05],其中噘嘴引起睑裂缩小是最常见的联带运动类型[55.32%(26/47)],联带运动严重程度和面肌痉挛严重程度无相关性,同时联带运动个数多少与面肌痉挛严重程度无相关性。结论原发性面肌痉挛联带运动发生占一定比例,其中噘嘴引起的睑裂减小、噘嘴引起的眉弓抬高、闭眼引起的口角牵动是最常见的三种联带运动模式,眼裂缩小是最常出现的联带运动动作,可为临床上联带运动的识别和面肌痉挛精细化治疗提供理论基础。联带运动是一种独立的现象,临床中应该重视对其的识别。

Objective To conclude the clinical manifestations of synkinesis in primary hemifacial spasm patients.MethodsIt is a retrospective study based on the clinical history and video of 212 hemifacial spasm patients.With the combination between videos and other studies,we categorized facial muscles into 3 regions（forehead,ocular and oris part）and chose 3 common facial movements of synkinesis（eyebrow lifted,eye closure and mouth corner lifted）.We also chose 5 voluntary facial movement（forehead winkled,frown,eye closure,teeth showing and pout）.And we analyzed demographic characteristics,clinical manifestations of different synkinesis and correlations between synkinesis and hemifacial spasm.Results The average age of patients was（56.07±12.40）years old and the average duration of disease was（54.90±59.96）months.As for 47 patients who did all five voluntary facial movements,oris-ocular synkinesis was the most common type of synkinesis[55.32%（26/47）].Pout was the most common voluntary movements which induced synkinesis[55.32%（26/47）,P〈0.01],eye closure was the most common synkinesis[57.45%（27/20）,P〈0.05],with pout induced eye closure was the most common type[55.32%（26/47）].There was no correlation between severity of hemifacial spasm and severity of synkinesis.Neither were severity of hemifacial spasm and numbers of synkinesis.Conclusion We observed that occurrence of synkinesis took a certain proportion in hemifacial spasm.Pout induced eye closure,pout induced eyebrow lifted and eye closure induced mouth corner lifted were 3 most common synkinesis which might be used for differentiate synkinesis from hemifacial spasm in clinic.Synkinesis was an independent clinical manifestation from hemifacial spasm.