面神经次全程减压术治疗颞骨外伤性面瘫

Facial nerve subtotal decompression surgery in patients with facial nerve paralysis after temporal bone trauma

目的探讨面神经次全程减压术治疗颞骨外伤性面瘫患者的临床处理与术后恢复情况。方法回顾性分析颞骨外伤致面瘫而行面神经次全程减压术治疗的病例资料,随访91例,分别按照年龄、起病快慢、外伤-手术时间、骨折部位分组,以House-Brackmann(HB)分级法作为疗效评估标准,统计学方法采用χ2检验或Fisher's矫正检验。结果患者术后面神经功能均有不同程度恢复,61.5%恢复至HB II级以内;年龄、起病快慢及骨折部位分组在疗效上差异无统计学意义;在受伤后3个月内和受伤3个月后手术者,功能恢复至HB II级以上分别为70.6%和34.8%,差异有统计学意义(χ2=9.309,P<0.05)。结论面神经次全程减压术对颞骨外伤性面瘫患者是一种有效的治疗手段;满足手术指征的患者应尽早接受手术,伤后3个月内手术者面神经功能恢复较好。

OBJECTIVE To explore the clinical effects of facial nerve decompression surgery in patients with facial nerve paralysis after temporal bone trauma and the patients＇ postoperative recovery. METHODS The clinical data of the patients with facial nerve paralysis after temporal bone trauma were studied retrospectively and 91 of them were followed-up. They were divided into different subgroups according to the age, onset character, the period of time between trauma and surgery and fracture location. RESULTS The number of patients who achieved good recovery of HBIor II was 56 of 91 （61.5%）. There was no difference in therapeutic outcomes among the subgroups classified by age, onset character and fracture location. The rate of good recovery to HB I or II in patients undergoing decompression surgery within 3 months after trauma reached 70.6%, compared with the rate 34.8% in patients undergoing the surgery after 3 months, resulting in a significantly better outcome （Х^2=9.309, P〈0.05）. CONCLUSION This study demonstrated that facial nerve subtotal decompression surgery was effective on the patients after temporal bone trauma. The ideal time for surgery was within the first 3 months after injury in patients with severe, immediate-onset paralysis.