椎动脉相关性面肌痉挛术后疗效的影响因素分析

Influencing factors for postoperative curative effect of vertebral artery-associated hemifacial spasm

目的探讨影响微血管减压术治疗椎动脉相关性面肌痉挛患者术后疗效的危险因素。方法以2018年6月至2019年6月在南京大学医学院附属鼓楼医院神经外科采用显微镜下微血管减压术治疗椎动脉相关性面肌痉挛的102例患者为对象,进行回顾性研究。根据术后随访是否痊愈分为痊愈组(84例)和未痊愈组(18例)。比较两组患者的相关临床资料,采用logistic回归分析与术后未痊愈相关的独立危险因素。结果术后,2例患者无效,4例复发,12例缓解,84例痊愈,总有效率为94.1%;术前的后颅窝夹角、双侧椎动脉共同压迫面神经与术后未痊愈的发生相关(P<0.05)。Logistic回归分析结果显示,双侧椎动脉参与压迫(OR=3.791,95%CI:1.132~12.698,P=0.031)及术前的后颅窝夹角大(OR=1.194,95%CI:1.048~1.361,P=0.008)是术后未痊愈的独立危险因素。结论椎动脉相关性面肌痉挛患者术后未痊愈的影响因素包括术前的后颅窝夹角大小和双侧椎动脉共同参与压迫面神经。

Objective To explore the risk factors for postoperative curative effect of microvascular decompression(MVD)in patients with vertebral artery-associated hemifacial spasm.Methods A retrospective study was conducted on 102 patients with vertebral artery related facial spasm who were treated by MVD under microscope in the Neurosurgery Department of Drum Tower Hospital affiliated to Nanjing University Medical School from June 2018 to June 2019.According to whether the patients were cured or not,they were divided into recovered group(84 cases)and non-recovered group(18 cases).The clinical data of the two groups were compared,and the independent risk factors related to postoperative non recovery were analyzed by logistic regression.Results The postoperative effects included 2 cases of inefficacy,4 cases of recurrence,12 cases of remission and 84 cases of recovery,with a total effective rate of 94.1%.The preoperative posterior cranial fossa angle and co-compression of facial nerve by bilateral vertebral arteries were related to uncured after operation(P<0.05).Logistic regression analysis showed that bilateral vertebral artery compression(OR=3.791,95%CI 1.132-12.698,P=0.031)and preoperative larger posterior fossa angle(OR=1.194,95%CI 1.048-1.361,P=0.008)were independent risk factors for postoperative non-recovering.Conclusion The influencing factors of non-recovering postoperative hemifacial muscle spasm in patients with vertebral artery-associated hemifacial spasm include the size of the posterior cranial fossa angle before surgery and the joint involvement of bilateral vertebral arteries in compressing the facial nerve.