神经环路阻断术治疗Meige综合征眼睑痉挛的效果及安全性

The efficacy and safety of nerve loop blocking in the treatment of blepharospasm in Meige syndrome

目的观察神经环路阻断术治疗Meige综合征所致眼睑痉挛的效果及安全性。方法回顾性病例系列研究。收集2018年4月至2020年1月在河南省直第三人民医院诊断为Meige综合征并接受神经环路阻断术的患者资料, 总结患者的一般资料、Meige综合征分型既往治疗情况、术前及随访的痉挛情况及术后并发症。手术前后对眼睑痉挛程度进行分级, 并采用Burke-Fahn-Marsden肌张力障碍运动评分量表(BFMDRS)对手术前后眼部、口部肌张力障碍的症状进行评分, 根据评分计算术后眼睑痉挛相对于术前的改善程度。主要采用Wilcoxon秩检验和Mann-WhitneyU检验进行统计学分析。结果共纳入199例患者, 其中男性64例(32.2%), 女性135例(67.8%);年龄58(51, 64)岁(22~79岁);术后随访时间为24(21, 28)个月。术前眼睑痉挛分级:3级12例(6.0%), 4级187例(94.0%);术后末次随访时眼睑痉挛分级:0级100例(50.3%), 1级64例(32.2%), 2级31例(15.6%), 3级4例(2.0%)。199例患者BFMDRS眼部评分术前为8.0(8.0, 8.0)分, 术后为0.0(0.0, 1.0)分(Z=-12.41, P<0.001);199例患者术后眼睑痉挛均有改善, 改善程度为100%(87.5%, 100%), 范围为43.8%~100%。不同性别和分型患者术后眼睑痉挛的改善程度差异均无统计学意义(均P>0.05)。65例眼睑痉挛合并口下颌肌张力障碍型患者BFMDRS口部评分术前为2.0(0.5, 4.5)分, 术后为1.0(0.5, 2.0)分(Z=-4.38, P<0.001), 其中38.5%(25/65)患者术后口部症状有改善。术后7.5%(15/199)患者出现下睑外翻, 100%(199/199)患者出现额部麻木, 89.9%(179/199)患者出现流泪, 无其他严重并发症。结论神经环路阻断术治疗Meige综合征眼睑痉挛是一种较为安全有效的方法。

Objective To evaluate the efficacy and safety of nerve loop blocking in the treatment of blepharospasm caused by Meige syndrome.Methods It was a retrospective case series study.Patients with Meige syndrome characterized by blepharospasm or blepharospasm-oromandibular dystonia who underwent nerve loop blocking in the Ophthalmology Department of Henan No.3 Provincial People′s Hospital from April 2018 to January 2020 were included.Before and after surgery,blepharospasm was graded,and the Burke-Fahn-Marsden Dystonia Rating Scale(BFMDRS)was used to score the symptoms of ocular and oral dystonia.The improvement rate of ocular spasm was calculated after surgery according to the scores.The postoperative complications were observed.The Wilcoxon rank test was used to compare the BFMDRS movement subscale scores before and after surgery.The independent sample Mann-Whitney U test was used to compare the improvement rates of eye spasm between male and female patients and between patients with and without combined oromandibular dystonia.Results Among the 199 patients included,64(32.2%)were males,and 135(67.8%)were females,aged 58(51,64)years(22-79 years).The postoperative follow-up period was 24(21,28)months.Preoperatively,blepharospasm was graded as grade 3 in 12 patients(6.0%)and grade 4 in 187 patients(94.0%),while the postoperative blepharospasm grades were grade 0 in 100 patients(50.3%),grade 1 in 64 patients(32.2%),grade 2 in 31 patients(15.6%),and grade 3 in 4 patients(2.0%).There was statistically significant difference in the BFMDRS scores of ocular dystonia before and after surgery[8.0(8.0,8.0)vs.0.0(0.0,1.0);Z=-12.41,P<0.001].The improvement rate of blepharospasm in all patients was 100%(87.5%,100%),ranging from 43.8%to 100%,with no statistically significant difference between patients of different genders and between patients with and without combined oral dystonia(both P>0.05).Statistically significant difference existed in the scores of oral dystonia before and after surgery[2.0(0.5,4.5)vs.1.0(0.5,2.0);Z=-4.38,P<0.001],with 25 of 65 patients(38.5%)having their oral symptoms improved.Postoperative complications included eyelid valgus(7.5%,15/199),frontal numbness(100%,199/199)and tearing(89.9%,179/199).Conclusion Nerve loop blocking is a relatively safe and effective method in the treatment of blepharospasm symptoms of Meige syndrome.