硬膜下超选择神经根切断术治疗痉挛性斜颈(附22例临床分析)

Subdural selective nerve rhizotomy of spasmodic torticollis

目的探讨经硬膜下超选择神经根切断治疗痉挛性斜颈的手术疗效。方法回顾分析我科自2004年1月~2014年1月收治的22例痉挛性斜颈患者,依据痉挛类型、肌电图结果、神经阻滞试验等明确原动肌及协从肌,行个体化超选择神经根切断术。术中借助电生理监测结果进行副神经根切断或减压、C1~C3脊神经前根高选择性部分切断,切断敏感性较高的神经根同时保留兴奋性较低的神经根。术后疗效评价6个月,随访时间6个月~6年。结果本组患者术后短期即获得不同程度的缓解,本组症状完全消失15例,明显好转3例,进步3例,无效1例,总有效率95.5%。本组无死亡、致残及恶化病例。结论经硬膜下超选择神经根切断治疗痉挛性斜颈安全有效,术前神经阻滞试验对判断参与痉挛发作的肌群及手术的可能疗效有重要意义,个体化的治疗方案有利于提高疗效并降低并发症发生,术中电生理监测是保证手术疗效、减少手术并发症的有效手段。

Objective To investigate the curative effect of subdural selective nerve rhizoto- my for spasmodic torticollis. Methods Retrospective analysis was taken on 22 cases suffered from spasmodic torticollis in our department from January 2004 to January 2014. Subdural selective nerve rhizotomy was performed on all the cases. We typed patients into different groups by clini- cal features, electromyogram results and nerve--block trials. Electrophysiology was performed during the operation in order to establish the highly sensitive nerves which should be cut off or decompressed. Patients were followed up in 0. 5-6 years in our study. Results All cases showed alleviate immediately after the operation. 15 cases stopped the spasm, 3 cases relieved rapidly, 3 cases showed improvement and 1 complained no remission in the follow--up period. The remission rate in this study was 95.5%. No fatal case, disabled case or concomitant symptoms occurred in the study. Conclusion Subdural selective nerve rhizotomy may be an effective microsurgical method for the treatment of spasmodic torticollis. The electromyogram results and nerve block trials is rather important for judging the criminal nerves. Electrophysiology during the operation and microsurgical techniques are keys to gain good effects.