痉挛性斜颈的手术治疗(附580例报道)

Neurosurgery for spasmodic torticollis(report of 580 cases)

目的探讨痉挛性斜颈(ST)的手术方法及其疗效。方法回顾性分析1995~2015手术治疗的580例痉挛性斜颈的临床资料。借助肌电图、CT或MRI等检查判断参与痉挛的肌群,将痉挛肌肉分为原动肌、协同肌、随动肌,对原动肌做去神经术和肌切断术,协同肌做去神经术,随从肌可不予处理,从而形成三种术式:术式一,面部旋向侧颈后痉挛肌肉选择性切除术;术式二,同侧颈神经1~6后支选择性切断术;术式三,副神经切断术。旋转型ST和侧屈型ST采用二联术或三联术,后仰型ST采用双侧术式一和术式二组合,前屈型ST采用双侧术式三组合,混合型ST分期采用颈部神经选择性切断术和肌肉选择性切除术。结果565例术后随访6个月~15年;术后6个月评估疗效:痊愈429例,显效68例,进步52例,无效16例;优良率为88%。无死亡、无严重并发症。结论选择性周围神经切断术及肌切断术是治疗痉挛性斜颈安全有效的方法。

Objective To investigate the curative effects of selective peripheral neurotomy and muscle amputation on the spasmodic torticollis(ST).Methods The muscles involved in the spasm were revealed by electromyography(EMG)and CT,or MRI examinations in 580 patients with ST.The muscles related to the spasm were divided into the prime mover which was cut off,synergistic muscles which were denerved and slave muscles which were not treated.The three kinds of surgical methods which were formed were as follows:(1)selective posterior cervical spam muscle resection;(2)selective posterior rhizotomy of cervical nerve 1～6(C1～6);(3)neurotomy of accessory nerve.The combination of the three methods is called"Triple treatment".The patients with rotatory ST and lateral flexion ST were treated by the triad or bigeminal methods.The patients with retrocollic spasm were bilaterally treated by the first and the second methods.The patients with mixed type ST were treated by selective cervical neurotomy and selective muscle resection.Results The following up for 6~12 months showed that of 565 followed up,429 were cured,68 received good outcomes,52 were on the mend and 16 had unchanged symptoms.The total excellent and good rate was 88.0%.No patients died and the serious complications did not occur in all the patients.Conclusion The selective peripheral neurotomy and muscle amputation are the safe and effective methods to treat ST.