神经导航辅助面神经管减压治疗颅底骨折后面瘫的临床及解剖观察

Clinical and anatomical observation of neuronavigation-assisted facial nerve tube decompression in treating paralysis of skull base fracture

目的探究神经导航辅助面神经管减压治疗颅底骨折后面瘫的临床效果和解剖学特点。方法选择2015年1月—2019年12月于我院接受治疗的中颅底骨折后面瘫患者30例作为研究对象,将患者随机分为保守治疗组和保守+手术治疗组,保守治疗组患者给予抗生素、激素、能量合剂维生素、中医药等药物对症治疗,针灸等康复治疗;保守+手术治疗组患者在保守治疗组基础上行神经导航引导下经耳后切口乳突面神经隐窝入路选择性面神经管减压治疗,比较两组患者面神经功能恢复情况。结果两组患者治疗前H-B分级比较无统计学意义,患者面神经功能无差异,保守+手术治疗组患者治疗后H-B分级显著优于保守治疗组,患者面神经功能更佳。保守治疗组治疗有效率、恢复理想率分别为63.64%(7/11)、27.27%(3/11),保守+手术治疗组分别为100%(19/19)、73.68%(14/19),两组患者比较具有明显差异。保守+手术治疗组患者面神经功能H-B分级改善效果更佳。结论神经导航辅助面神经管减压治疗颅底骨折后面瘫具有较好的临床效果,手术精度高、风险小,能有效保护神经功能,符合微创外科理念,具有良好的应用前景。

Objective:To explore the clinical effects and anatomical features of neuronavigation assisted facial nerve tube decompression in the treatment of paralysis of the skull base fracture.Methods:30 patients with paralysis of the middle skull base fracture who were treated in our hospital from January 2015 to December 2019 were selected as the research subjects,and the patients were randomly divided into conservative treatment groups and conservative+surgery treatment groups.Patients in the conservative treatment group were given antibiotics,hormones,energy mixture vitamins,Chinese medicine and other drugs for symptomatic treatment,acupuncture and other rehabilitation treatments;Patients in the conservative+surgical treatment group under the guidance of the basic ascending nerve navigation in the conservative treatment group were treated with selective facial nerve tube decompression through the posterior incision mastoid facial nerve crypt approach,and the recovery of facial nerve function between the two groups was compared.Results:There was no significant difference in HB classification before treatment between the two groups of patients,and there was no difference in facial nerve function.The HB classification of patients in the conservative+surgery treatment group was significantly better than that in the conservative treatment group,and the facial nerve function was better.The effective rate and ideal recovery rate of the conservative treatment group were 63.64%(7/11)and 27.27%(3/11),and the conservative+surgery treatment groups were 100%(19/19)and 73.68%(14/19).There was a significant difference between the two groups of patients.The improvement of H-B grade of facial nerve function was better in the conservative+surgery group.Conclusion:The neuronavigation assisted facial nerve tube decompression has good clinical effect in treating paralysis of the back of the skull base fracture,with high accuracy and low risk of operation,can effectively protect the nerve function,accords with the minimally invasive surgical concept,and has good application prospects.