微血管减压术治疗面肌痉挛的术前评估与手术及预后的关系研究

Study on the relationship between preoperative evaluation, operation and prognosis of microvascular decompression for the treatment of hemifacial spasm

目的探讨微血管减压术(MVD)治疗面肌痉挛(HFS)的术前评估与手术及预后的关系。方法回顾性分析128例在浙江省台州医院神经外科行MVD治疗的HFS患者的临床资料,根据三星医疗中心(SMC)评分系统,将患者分为一般痉挛组和严重痉挛组,比较两组患者的临床特点、责任血管、预后及手术并发症等情况。结果一般痉挛组年龄(48.6±10.6)岁,病程(4.2±3.3)年,严重痉挛组年龄(51.8±9.9)岁,病程(8.1±4.5)年,两组患者年龄、病程的差异均有统计学意义(均P<0.05)。一般痉挛组中责任血管为小脑前下动脉(AICA)者41例,小脑后下动脉(PICA)者21例,椎动脉者1例,单一责任血管者共63例,多支责任血管者7例;严重痉挛组中责任血管为AICA者29例,PICA者13例,椎动脉者2例,单一责任血管者共44例,多支责任血管者14例;两组患者多支责任血管者所占比例有明显差异,且差异有统计学意义(P<0.05)。两组患者术后随访12~32个月,有效率、复发率差异无统计学意义(P>0.05);两组患者各种术后并发症均有一定差异,术后迟发性面瘫的发生率差异有统计学意义(P<0.05),其余并发症差异均无统计学意义(P>0.05)。结论相对于一般痉挛组,严重痉挛组年龄大,病程长,多支责任血管压迫概率高,术后迟发性面瘫的发生率高;因此,术前SMC评分有助于术者对术中及术后情况的评估与预判,值得临床广泛推广应用。

Objective To investigate the relationship between preoperative evaluation,surgery and prognosis of microvascular decompression (MVD) for the treatment of hemifacial spasm (HFS).Methods The clinical data of 128 HFS patients treated with MVD in the department of neurosurgery of Taizhou Hospital of Zhejiang Province were retrospectively analyzed.According to the SMC grading system,the patients were divided into general spasm group and severe spasm group,and the clinical characteristics,offending vessel,prognosis and surgical complications of the two groups were compared.Results In the general spasm group,the age at MVD was (48.6±10.6) years,the disease duration was (4.2±3.3) years;while in the severe spasm group,the age at MVD was (51.8±9.9) years,the disease duration was (8.1±4.5) years;the differences of age and disease duration between the two groups were statistically significant (P<0.05).In the general spasm group,there were 41 cases in which the offending vessel were AICA,21 cases were PICA,1 case was VA,63 cases were single offending vessel,and 7 cases were multiple offending vessels.In the severe spasm group,there were 29 cases in which the offending vessel were AICA,13 cases were PICA,2 cases were VA,the total of 44 cases were single offending vessel and 14 cases were multiple offending vessels.There was a significant difference in the proportion of multiple offending vessels in the two groups,and the difference was statistically significant (P<0.05).Patients in the two groups were followed up for 12 to 32 months after surgery,and the difference in effective rate and recurrence rate was not statistically significant (P>0.05).Some kinds of postoperative complications were different between the two groups,the incidence of postoperative delayed facial paralysis was statistically significant (P<0.05),and the other complications were not statistically significant (P>0.05).Conclusion Compared with the general spasm group,the patients in the severe spasm group were older,with longer disease duration,higher probability of multiple offending vessels and higher incidence of postoperative delayed facial paralysis.Therefore,preoperative SMC grading is helpful for the evaluation and prediction of intraoperative and postoperative conditions,which is worthy of wide clinical application.