颞骨骨折性面瘫患者临床特点与术后疗效分析

Clinical characteristics and postoperative efficacy of patients with temporal fracture facial paralysis

目的探讨颞骨骨折性面瘫患者的临床特点与术后疗效。方法回顾性分析接受手术治疗的31例颞骨骨折性面瘫(纵行骨折8例,横行骨折10例,混合型骨折13例)患者的临床资料,观察其临床特点与治疗结果,以HouseBrackmann(H-B)分级法评估术后疗效。结果 (1)颞骨骨折合并面瘫31例,共55段面神经受累,其中鼓室段(19/55)及膝状神经节(18/55)为最常见受损节段,其次为乳突段(12/55)、迷路段(6/55)。(2)传导性耳聋在纵行骨折和横行骨折中的发生率分别为37.5%和10.0%,差异无统计学意义(P>0.05)。感音神经性耳聋在横行骨折中的发生率为70%,高于在纵行骨折中的发生率12.5%,差异有统计学意义(P<0.05)。(3)面神经减压术后2~7个月以内恢复至H-BⅠ~Ⅱ级27例(87.1%)、Ⅲ级4例(12.9%)。面瘫病程≤2个月者术后恢复效果优于>2个月者,差异有统计学意义(P<0.05)。结论颞骨骨折合并面瘫患者及早进行面神经减压手术治疗,多可获得较好疗效。

Objective To investigate the clinical characteristics and postoperative efficacy of patients with temporal fracture facial paralysis. Methods The clinical data of 31 patients with temporal fracture facial paralysis （ 8 cases of longitudinal frac- ture, 10 cases of transverse fracture, and 13 cases of mixed fracture） who underwent surgery- in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. Tile characteristics and treatment outcomes were assessed by tile House - Brackmann （H - B） grading method. Results Temporal bone fractures were found in 31 cases with facial paralysis, Umpanic segment （19/55） and geniculate ganglion （18/55） were the most common segments, followed by mastoid segment （12/55） and labyrinth segment （6/55）. The incidence of conductive deafness in longitudinal and transverse fractures was 37. 5% and 10% , respectively（ P 〉 0. 05 ）. The incidence of sensorineural deafness in transverse fractures was 70% , which was higher than that in longitudinal fractures （ 12. 5% ） （P 〈0. 05）. Thirty - one cases of temporal bone fracture facial paralysis were treated with facial nerve decompression. After 2 -7 months, 27 patients （87.1%） had grades H - B I - II and 4 patients （ 12. 9% ） had grade III. The recovery- effect of facial paralysis in patients with disease course less than 2 months after surgery was better than that with more than 2 months, and the difference was statistically significant （ P 〈 0. 05 ）. Conclusion Patients with zygomatic fracturesand facial paralysis undergoing facial nerve decompression surgeryearlier can obtain better results.