动力性肌肉游离移植治疗面瘫的前瞻性研究

Prospective study on the treatment of facial palsywith dynamic free muscle transplantation.

作者根据目前吻合神经血管的肌肉游离移植治疗陈旧性面瘫的三种术式，将患者随机分为三组，１组是在健面侧吻合神经血管的超长蒂节段性背阔肌一期跨面移植（一期法），共９例；２组是跨面神经移植和二期肌肉游离移植（二期法），共７例；３组是在患面侧吻合神经血管的肌肉游离移植，共５例。对随访时间在１年以上、资料完整的１６例进行了效果评定，功能恢复优良率达９３．８％。各组之间无显著差异。效果优良者主要分布在４０岁以内年龄段上，与病因和病程无关。分析认为一期法中，神经蒂保留了生理性血液循环，再生速度和质量均不亚于吻合静脉的腓肠神经移植，避免了二期法中再生神经纤维通过两个吻合处时的“衰减”；术式本身兼顾提面术和选择性神经切断术，从而获得良好的近期效果，远期效果也很乐观；与二期法相比，大大缩短了疗程。

Abstract In this prospective study , patients were random-ly divided into 3 groups according to 3 different opera-tion procedures used to correct facial palsy with mi-croneurovascular anastomosed muscle transplanta-tion : In group 1 , 9 patients accepted cross face trans-plantation of segmental latissimus dorsi muscle flapwith super-long neurovascular pedicle, through up-per labial tunnel, anastomosed in normal face (onestage method) ;In group 2, 7 patients accepted crossface nerve graft and secondary free muscle transplan-tation by neurovascular anastomoses in paralyzed face(two stage method): In group 3, 5 patients, freemuscle transplantation by microneurovascular anasto-mosis in paralyzed face. The appreciation for the re-sults was carried out in 16 patients who had been fol-lowed-up more than 1 year. In terms of functionalrecovery, the success rate ranged in excellent andgood reached 93. 8%. There were not significant dif-ferences among groups. The patients of less than 40-year-old got better results and the correlation be-tween operative effects and both cause and course ofdisease could not be found. It was considered that thenerve regeneration speed and quality in one stagemethod were better than sural nerve graft with smallsaphenous vein anastomosis. because physiologicalblood supply was kept well along the nerve pedicleand regenerating nerve fibers need not pass throughtwo suture sites. Patients satisfied the results afterthe swelling was gone because one stage method hadthe advantages of face lift and selective neurotomy atthe same time. The course of treatment was short-ened significantly as well.