微血管减压术治疗面肌痉挛的疗效分析

Analysis of microvascular decompression for hemifacial spasm

目的分析微血管减压术治疗面肌痉挛患者的临床疗效。方法选取本院神经外科2012年1月~2017年3月收治的采用微血管减压术治疗的面肌痉挛患者112例,术前患者面肌痉挛程度进行评分,手术治疗后进行随访及术后评估,统计分析患者手术临床疗效和预后情况。结果来源于小脑前下和后下动脉的责任血管有85例,占75.89%,来源于椎动脉的责任血管有14例,占12.50%,来源于其它血管的责任血管有13例,占11.61%,责任血管来源于小脑前下和后下动脉的患者数明显高于来源于椎动脉、其它血管的患者数,差异具有统计学意义(P<0.05)。面肌痉挛患者术后1周内完全消失81例,占72.32%,改善12例,占10.71%,无效19例,占16.97%,复发0例;术后6个月内完全消失92例,占82.14%,改善10例,占8.93%,无效10例,占8.93%,复发0例;术后12个月内完全消失103例,占91.96%,改善4例,占3.57%,无效2例,占1.79%,复发3例,占2.68%。面肌痉挛患者术后1周内耳鸣8例,占7.14%,面瘫7例,占6.25%,听力下降14例,占12.50%,总并发症发生29例,占25.89%;术后12个月内耳鸣5例,占4.46%,面瘫1例,占0.89%,听力下降9例,占8.04%,总并发症发生15例,占13.39%;术后12个月内面肌痉挛患者总并发症发生率明显低于术后1周内,差异具有统计学意义(P<0.05)。结论微血管减压术治疗面肌痉挛患者临床疗效较好,其手术技术成熟,手术部位明确,术后并发症发生较少,值得临床借鉴推广使用。

Objective To analyze the clinical efficacy of microvascular decompression for hemifacial spasm.Methods The hospital department of neurosurgery from January2012to March2017were treated with112patients with hemifacial spasm microvascular decompression in the treatment of patients,patients with hemifacial spasm degree score before surgery,after surgery and postoperative follow-up assessment,statistical analysis of clinical efficacy and prognosis of surgical patients.Results The source of responsibility in blood vessels of anterior inferior cerebellar artery and85cases,accounting for75.89%,the responsibility of vessels originating from the vertebral artery in14cases,accounting for12.50%,responsible vessels from other vessels in13cases,accounting for11.61%,the number of patients in the number of patients with the source of responsible vessels of anterior inferior cerebellar artery and posterior inferior from the vertebral artery,was significantly higher than that of other vessels,the difference was statistically significant(P<0.05).Hemifacial spasm patients within1weeks after the operation completely disappeared in81cases,accounting for72.32%,improved in12cases,accounting for10.71%,invalid in19cases,accounting for16.97%,0cases of recurrence;postoperative6months disappeared completely in92cases,accounting for82.14%,improved in10cases,accounting for8.93%,invalid in10cases,accounting for8.93%,0recurrence cases;within12months after the operation completely disappeared in103cases,accounting for91.96%,improved in4cases,accounting for3.57%,invalid in2cases,accounting for1.79%,3cases of recurrence,accounting for2.68%.Hemifacial spasm patients after1weeks of tinnitus in8cases,accounting for7.14%,accounting for6.25%,7cases of facial paralysis,hearing loss in14cases,accounting for12.50%,29cases,the total complication rate was25.89%;tinnitus within12months after the surgery in5cases,accounting for4.46%,1cases of facial paralysis,accounted for0.89%,9cases of hearing loss.Accounted for8.04%,15cases,total complications accounted for13.39%of total complications occurred;hemifacial spasm patients within12months after1weeks was significantly lower than that after the surgery,the difference was statistically significant(P<0.05).Conclusion Microvascular decompression treatment of hemifacial spasm patients with better clinical efficacy,mature surgical techniques,surgical site is clear,postoperative complications occur less,it is worth clinical reference,promotion and use.