痉挛型斜颈手术治疗45例临床分析

The clinic observation of operative treatment for 45 patients with spasmodic torticollis

目的观察选择性颈肌切断和（或）选择性周围神经切断治疗痉挛型斜颈的疗效。方法45例痉挛性斜颈（其中旋转型35例、侧屈型8例、双侧后仰型及双侧前屈型各1例，无混合型），根据病情选择副神经切断及胸锁乳突肌部分切除（术式一）和（或）头旋向侧选择性颈后肌切除或部分切除（术式二）、同侧颈神经1～6后支选择性切断（术式三）。本组病例采用术式一2例，二联术（术式一、二合用）8例、三联术（三种术式合用）32例，术式二、三合用3例。疗效评定时间为术后1年，随访2年。结果45例经治疗痊愈31例，显效9例，进步3例，无效1例，恶化1例，总有效率95．57％。无死亡、致残病例，无并发症。结论选择性颈肌切断和（或）选择性周围神经切断是治疗痉挛型斜颈安全、有效的方法。

Objective To investigate the effect of operative procedure the amputation of selective resection of the cervical muscu lature with/or selective neueotomy of accessory nerve or posterior branch of C1-6 nerve on patients with spasmodic torticollis. Methods In accordance with the patients＇ condition,operative procedures the amputation of accessory nerve and selective resection of sternocleidomastoid muscle（operative procedure Ⅰ ）with/or the selective resection of posterior cervical spasmodic musceles（operative procedure Ⅱ ）, the amputation of posterior branch of C1-6 nerve（operative procedure Ⅲ ） were chosen for the treatment of 45 cases（spinner 35 cases,lateral flexion 8 cases, hypsokinesis 1 case andanteflexion 1 case）. In the observition,operative procedure Ⅰ was chosen for 2 cases, Ⅰ associated with Ⅱ for 8 cases, Ⅰ combiningⅡ and Ⅲfor 32 cases, Ⅱ associated with Ⅲ for 3 cases. The effect were assessed 1-year-later,while patients have been followed up for 2 years. Results Through the treatment,31 of the 45 cases showed recovery,9 showed excellent results,3 improvement, 1 inefficacy and 1 relapse. The total efficiency was 95.57%. And there were not fatal case,disabled case and concomitant symptom. Conclusion Operative procedure the amputation of selective resection of cervical musculature with/or selective neueotomy of accessory nerve or posterior branch of C1-6 nerve should be guarded and effictive for spasmodic torticollis.