两次改良Foerster-Dandy手术治疗痉挛性斜颈的对比研究

Modified Foerster- Dandy＇s operation for the treatment of spasmodic torticollis under endoscope-assisting

目的对比两次改良Foerster-Dandy手术治疗痉挛性斜颈的疗效及并发症。方法回顾分析183例痉挛性斜颈患者，其中A组126例采用改良Foerster-Dandy手术，B组57例采用在硬性神经内镜辅助下二次改良的Foerster-Dandy手术。结果全部患者平均随访33．4个月。两组患者术后均立即感觉痉挛状态明显缓解，差异无统计学意义（P〉0．05）。A组36例发生不同程度吞咽困难，随访期间恢复正常18例，明显好转11例，无明显变化而影响生活质量7例；B组8例发生不同程度吞咽困难，随访期间恢复正常5例，明显好转2例，无明显变化而影响生活质量1例（该例仅随访1个月），差异有统计学意义（P〈0．05）。A组颅内感染10例（7．9％），B组颅内感染2例（3．5％），出院前均治愈，差异有统计学意义（P〈0．05）。B组手术时间较A组手术时间显著减少，差异有统计学意义（P〈0．05）。B组术中平均失血量较A组明显减少，差异有统计学意义（P〈0．05）。结论硬性神经内镜辅助下二次改良的Foerster-Dandy手术，术中不咬除枕骨鳞部及枕大孔，在不降低疗效及不增加神经系统并发症的前提下，可进一步减少手术创伤，缩短手术时间，减少术中失血量，增加寰枕部稳定性，明显降低并发症的发生率。

Objective To study the microsurgical effectiveness of modified Foerster-Dandy＇s operation for the treatment of spasmodic torticollis under endoscope - assisted. Method 183 cases of spasmodic torticollis patients were treated by microsurgical modified Foerster - Dandy＇s operation from July 2001 to June 2009, which was randomly classified into group A and group B. Group A（ 126 eases） were treated by firstly modified Foerster - Dandy＇s operation. Group B （57 cases ） were treated by microsurgieal modified Foerster - Dandy＇s operation under endoscope - assisting. The other surgical steps were same with firstly modified Foerster- Dandy＇s operation. Results All the patients were averagely followed up for 33.4 months after the surgery. The spastieity was relieved immediately after the operation in all the patients. In group A, dysphagia in different degree in 36 cases, in whom, dysphagia was disappeared in 18 cases, dysphagia was significantly relieved in 11, and unchanged in 7 during the following-up period, In group B, dysphagia was in different degree in 8 cases ,in whom,dysphagia was disappeared in 5 eases,dysphagia was significantly relieved in 2, and unchanged in 1 （ follow - up only one month） （ P 〈 0. 05 ）. The intracranial infection rates in A and B groups were 7.9% and 3.5% respectively（ P 〈0.05）. The mean operative time was also significantly shorter in Group B than in Group A（ P 〈 O. 05 ）. The mean intraoperalive blood loss in Group B was less than in Group A（ P 〈 0.05 ）. Conclusions Modified Foerster- Dandy＇s operation can be done under endoscope-assisted, without resection of occipital squama and foramen magnum. This modified operation is able to keep the efficacy and do not increase the nervous system complications. It further reduces the surgical injury and intraoperative blood loss, increases the stability of the atlanto - occipital, and significantly desereases the incidence of intraeranial complications.