面肌痉挛显微血管减压手术后面瘫的探究

Investigation of facial paralysis after microvascular decompression for hemifacial spasm

目的探讨面肌痉挛(hemifacial spasm,HFS)行显微血管减压术(microvascular decompression,MVD)后面瘫的转归、影响因素及应对措施。方法回顾性分析MVD治疗128例面肌痉挛病人的临床资料,术后出现面瘫30例,统计分析可能影响面瘫恢复的因素。结果所有病人随访5～18个月,House-BrackmannⅢ(H-BⅢ)级及以上病人共7例。面肌痉挛不同病程间术后面瘫的发生率存在差异(P <0.05),不同面瘫的起始级别、发生时间之间面瘫的持续时间差异均存在统计学意义(P <0.05)。Logistic回归分析:面肌痉挛病程与面瘫的发生相关(OR=0.404,95%CI:0.175～0.934,P=0.034);面瘫发生时间对面瘫持续时间的影响有统计学意义(P=0.020),面瘫起始级别对面瘫持续时间的影响无统计学意义(P=0.070)。结论面肌痉挛MVD术后面瘫的发生率较高,但预后良好;面肌痉挛病程越长,手术后并发面瘫的可能性越大,术后面瘫发生时间越早,面瘫持续的时间越长。

Objective To investigate the outcomes, influencing factors and countermeasures of facial paralysis after microvascular decompression（MVD） for hemifacial spasm. Methods Clinical data of 128 hemifacial spasm patients undergoing MVD were analyzed retrospectively. Facial paralysis was observed in 30 patients. The related factors affecting the recovery of facial paralysis were analyzed statistically. Results The patients were followed up for 5 to 18 months, there were 7 patients with House-Brackmann Ⅲgrade（H-BⅢ） and above. There was a difference in rate of facial paralysis between hemifacial spasm durations（P 0.05）. There were differences in duration of facial paralysis between different initial levels and occurrence times of facial paralysis（P 0.05）. Logistic regression analysis showed that the duration of facial spasm was related to the occurrence of facial paralysis（OR = 0.404, 95%CI：0.175 to 0.934, P = 0.034）. The influence of occurrence time of hemifacial paralysis on the duration of facial paralysis was statistically significant（P = 0.020）, but there was no significant difference in influence of initial levels of facial paralysis on the duration of facial paralysis（P = 0.070）. Conclusions The incidence of facial paralysis is higher in hemifacial spasm patients after MVD, but the prognosis is good. The longer the duration of hemifacial spasm is, the bigger the possibility of complicated facial paralysis after surgery will be. The earlier the occurrence time of facial paralysis is, the longer the duration of facial paralysis will be.