两种不同路径微血管减压术治疗面肌痉挛的近远期疗效对比研究

Study of the short and long term effects of two different methods of microvascular decompression in the treatment of facial spasm

目的:对比研究不同路径微血管减压术(MVD)在面肌痉挛治疗中的近远期疗效。方法:将我院收治的68例面肌痉挛患者随机分为常规MVD组34例和全程MVD组34例。对比两组患者的近期临床干预成功率;并于手术前后检测神经电生理指标,监测手术并发症,并随访(术后1年)统计远期复发率。结果:全程MVD组患者近期临床干预成功率为97.06%,高于常规MVD组的82.35(P<0.05)。术后,全程MVD组面神经传导速度高于常规MVD组(P<0.05),面神经F波时限、面神经CMAP波幅均小于常规MVD组(P<0.05)。在手术并发症发生率上,常规MVD组和全程MVD组依次为11.76%、14.71%,两组比较,P>0.05。在远期随访中,常规MVD组复发率为6.67%,全程MVD组为0,两组比较,P>0.05。结论:相较于常规MVD术,乙状窦后入路面神经根全程MVD治疗面肌痉挛能更全面的解除面神经根压迫,抑制面神经异常兴奋,近远期疗效显著。

Objective:To compare the short-term and long-term effects of microvascular decompression(MVD)in the treatment of facial spasm.Methods:68 patients with hemifacial spasm admitted to our hospital were randomly divided into conventional MVD group(n=34)and full MVD group(n=34).The success rate of recent clinical intervention was compared between the two groups.Neuroelectrophysiological indicators were detected before and after the operation,surgical complications were monitored,and the long-term recurrence rate was calculated by followup(1 year after the operation).Results:The success rate of recent clinical intervention in whole-course MVD group was 97.06%,higher than 82.35%in conventional MVD group(P<0.05).After operation,the conduction velocity of facial nerve in MVD group was higher than that in conventional MVD group(P<0.05),and the F wave duration and CMAP wave amplitude of facial nerve in MVD group were lower than those in conventional MVD group(P<0.05).The incidence of surgical complications in conventional MVD group and full MVD group was 11.76%and 14.71%,respectively,P>0.05.In the long-term follow-up,the recurrence rate of the routine MVD group was 6.67%,and that of the whole MVD group was 0,P>0.05.Conclusion:Compared with conventional MVD,the treatment of facial spasm with MVD in the whole process of retrosigmoid sinus entry into pavement nerve root can relieve the compression of facial nerve root more comprehensively and inhibit facial nerve excitation,with significant short-term and long-term efficacy.