垂直段损伤面神经减压术式选择

Choice of operation in facial nerve decompression of mastoid segment injuries

目的:探讨面神经全段减压术和垂直段减压术治疗面神经垂直段损伤所致周围性面瘫疗效。方法:按House和Brackmann评分法对63例面神经垂直段损伤致面瘫患者进行术前、术后的面神经功能评估。所有患者皆行耳后切口,26例经乳突一上鼓室进路全段面神经减压术;28例仅行垂直段面神经减压术;5例行面神经端端吻合术;4例行面神经移植术。结果:术后1年评估:垂直段减压术28例,Ⅰ级恢复者11例,Ⅱ级恢复者10例,Ⅲ级恢复者7例。全段减压术26例,Ⅰ级恢复者9例,Ⅱ级恢复者11例,Ⅲ级恢复者6例。两者比较差异无统计学意义(P>0.05)。术后面神经功能恢复程度与病程有密切的正相关关系。面神经吻合和移植术后,面神经功能恢复多不理想。结论:垂直段面神经损伤性面瘫,术后功能恢复与减压术式无明显关系,而与病程和损伤程度有关。

Objective： To investigate the effects of whole facial nerve decompression and vertical segment of facial nerve decompression on peripheral facial paralysis caused by vertical segment of facial nerve injuries.Methods： Function of facial never in 63 patients with vertical segment of facial nerve injuries pre and post operation were evaluated with House and Brackmann scales.Twenty six cases underwent whole facial nerve decompression by mastoid-attic approach,28 underwent vertical segment of facial nerve decompression,5 underwent facial nerve anastomosis,and 4 underwent facial nerve transplantation.Result： Assessment of facial nerve function one year after the operation showed： 11 of the 28 cases that underwent vertical segment of facial nerve decompression were evaluated as grade Ⅰremission,10 as grade Ⅱ remission and 7 as grade Ⅲ,9 of the 26 patients that underwent vertical segment of facial nerve decompression were evaluated as gradeⅠremission,11 as grade Ⅱ,and 6 as grade Ⅲ,showing no significant difference between the 2 groups.However,the remission degree was correlated with the disease course.For those underwent facial nerve transplantation haven＇t obtained satisfactory facial nerve function.Conclusions： For peripheral facial paralysis caused by vertical segment of facial nerve injuries,postoperative recovery status was not correlated with decompression method,but with the injury severity and disease course.