手术与药物治疗颅底骨折致迟发型面神经麻痹的疗效观察

Therapeutic effect of surgical and drug treatment on delayed facial nerve paralysis caused by skull base fracture

目的探讨手术与药物治疗颅底骨折致迟发型面神经麻痹的临床疗效。方法选择2016年1月～2017年5月在我院诊断治疗的颅底骨折所致的迟发性面神经麻痹患者100例为研究对象,随机分为A组与B组各50例。A组采用β-七叶皂苷钠治疗,B组采用手术治疗。比较治疗1周、4周后两组临床疗效,随访1年比较两组House-Brackmann面瘫分级。结果治疗1周后,A组痊愈率占10.0%,B组26.0%;秩和检验结果显示,B组治疗1周后临床疗效优于A组,差异有统计学意义(P<0.05)。治疗4周后,A组痊愈率占32.0%,B组76.0%;秩和检验结果显示,B组治疗4周临床疗效优于A组,差异有统计学意义(P<0.05)。随访1年,B组House-Brackmann面瘫分级为Ⅰ级的占80%,A组Ⅰ级占40%;秩和检验分析显示B组随访1年House-Brackmann面瘫分级显著优于A组,差异有统计学意义(P<0.05)。结论手术治疗颅底骨折致迟发型面神经麻痹能促进面神经麻痹恢复,提高临床疗效。

Objective To explore the clinical efficacy of surgical and drug treatment of delayed facial nerve paralysis caused by skull base fracture. Methods 100 patients with delayed facial paralysis caused by skull base fracture diagnosed and treated in our hospital from January 2016 to May 2017 were selected and randomly divided into group A and group B, each with 50 cases. Group A was treated with β-aescin sodium, and group B was treated with surgery. The clinical efficacy after 1 week and 4 weeks of treatment was compared between the two groups. The House-Brackmann facial paralysis grades were compared after a year of follow up. Results After 1 week of treatment, the cure rate of group A was 10.0%, and that of group B was 26.0%. The results of rank sum test showed that the clinical effect of group B was better than that of group A after 1 week of treatment, and the difference was statistically significant(P<0.05). After 4 weeks of treatment, the cure rate of group A accounted for 32.0%, and that of group B was 76.0%. The results of rank sum test showed that the clinical effect of group B was better than that of group A after 4 weeks of treatment, and the difference was statistically significant(P<0.05). During the 1-year follow up, the Group-Brackmann facial paralysis grade showed 80% of grade Ⅰ in group B, which was 40% in group A. The rank sum test analysis showed that the Group-Brackmann facial paralysis grade was significantly better in group B than in group A, and the difference was statistically significant(P<0.05). Conclusion Surgical treatment of delayed skull facial paralysis caused by skull base fracture can promote the recovery of facial nerve paralysis and improve clinical efficacy.