面肌痉挛微血管减压术后持续性异常肌反应对预后的影响

Effects of persistent abnormal muscle response after microvascular decompression on prognosis in patients with hemifacial spasm

目的探讨异常肌反应(AMR)在面肌痉挛(HFS)微血管减压术(MVD)后持续存在的意义。方法回顾性分析2012年2月至2017年2月MVD治疗的168例HFS的临床资料。术中进行电生理监测记录AMR波,其中162例监测到AMR波,术后130例AMR波形消失(AMR波消失组),32例波形未消失(AMR波未消失组)。结果 AMR波消失组术后即刻治愈率(90.8%,118/130)明显高于AMR波未消失组(46.9%,15/32;P<0.05)。两组术后并发症发生率无统计学差异(3.8%vs. 3.8%;P>0.05)。AMR波消失组128例获得随访,随访时间13~71个月,平均41.2个月;AMR波未消失32均获得随访,随访时间15~70个月,平均43.6个月。AMR波消失组随访治愈率(94.5%)与AMR波未消失组(93.8%)无统计学差异(P>0.05)。结论 HFS病人MVD中,AMR监测对判断面神经减压是否充分具有一定的指导价值;术后AMR波形持续存在并不意味着预后不佳。

Objective To explore the effects of persistent abnormal muscle response (AMR) after microvascular decompression (MVD) on the prognosis in the patients with hemifacial spasm (HFS). Methods The clinical data of 162 patients with HFS, who underwent MVD in our hospital from February, 2012 to February, 2017, were analyzed retrospectively. AMR was intraoperatively and postoperatively monitored in all the patients. Of these 162 patients, 32 had AMR and 130 not after MVD . The clinical features and surgical outcomes were compared between both the patients with postoperative AMR and ones without postoperative AMR. Results The cured rate (90.8%, 118/130) was significantly higher in the patient without postoperative AMR than that (46.9%, 15/32)in the patients with postoperative AMR immediately after MVD (P<0.05). There were no significant differences in the preoperative clinical characteristics, postoperative complications and long-term (15~70 months after MVD)curative effects between the two groups (P>0.05). Conclusions AMR is helpful to intraoperative identification of the offending vessel and adequate decompression, but it is not helpful to the prediction of the long-term curative effects in the patients with HFS undergoing MVD.