面肌锻炼为主治疗面神经炎面肌瘫痪

Treatment of Bell's Palsy Mainly by Facial Functional Exercise with Motion Inhibition of the Unaffected Side

目的:观察健侧面肌制动,患侧面肌锻炼为主对面神经炎一侧面肌瘫痪功能恢复的作用。方法:急性面神经炎面肌瘫痪患者291例,分为对照组70例和观察组221例,均采用药物联合传统瘫痪面肌抬眉、闭眼、耸鼻、示齿、噘嘴及鼓腮等锻炼法。观察组在进行上述面肌锻炼时对健侧面肌制动。2组治疗前和治疗后第5,10天及3个月后随访,分别以House-Brackmann面神经分级标准进行评分和疗效评定。结果:治疗第5,10天和出院后3个月面神经分级对比发现,面神经功能缺损恢复的效果与面肌锻炼总时间的长短明显相关(QCMH=205.9903,P<0.01)。治疗第10天时,2组House-Brackmann面神经分级达1级的例数明显多于治疗第5天时,且观察组明显多于对照组(均P<0.01),其治愈率及总有效率也明显高于对照组(31.7%,99.1%与22.9%,71.4%,P<0.05)。3个月后随访,观察组面肌功能恢复的例数明显多于对照组(P<0.01)。2组均无并发症发生。结论:健侧制动面肌锻炼法能激发患者自行锻炼的主动性,提高瘫痪面肌功能恢复的速度和程度,并能节约治疗开支。

Objective： To search for a best combined therapy for facial palsy caused by facial neuritis,which may maximally recover the function of facial muscles and shorten the time of recovery.Methods： Seventy patients in the control group were treated with routine therapy and conventional exercise of the paralytic facial muscles.In the observation group of 221 consecutive patients,routine therapy plus facial functional exercise with motion inhibition of the unaffected side were applied.Facial palsy was assessed using the House-Brackmann Scale before and on the fifth and tenth day of treatment,respectively.Some patients were followed up for three months.All data were analyzed statistically.Results： Facial nerve function grading at 5th and 10th day after treatment and 3rd month after discharge showed that the recovery of neurologic impairment was obviously correlated to the overall time course of facial functional exercise（QCMH=205.9903,P0.001）.The therapeutic effect of the observation group apparently surpassed that of the control goup（QCMH=16.083,P0.001）.On the 10th day of treatment,total effective rate in the observation group was significantly higher than in the control group（P=0.014）.The total effective rate of both groups was 100% three months after discharge.No complications related to facial exercise occurred.Conclusion： Facial functional exercise with motion inhibition of the unaffected side is more effective than conventional exercise.It shortens the recovery time of facial nerve function,and may push the facial recovery to a greater extent.