外伤性面瘫患者面神经减压术不同手术时机对预后的影响

Influence of different operation timing on prognosis of traumatic facial paralysis patients undergoing facial nerve decompression

目的研究外伤性面瘫患者面神经减压术不同手术时机对预后的影响。方法回顾性选取2019年2月至2021年10月空军军医大学唐都医院耳鼻咽喉头颈外科收治的60例外伤性面瘫患者,根据不同手术时机分为<1个月组(n=18)、1~2个月组(n=15)、3~6个月组(n=16)、>6个月组(n=11),实施面神经减压术。采用House-Brackmann(H-B)面神经功能分级量表评估各组术后1年面神经功能及康复率,并评估面神经功能指数(FNFI)评分。结果术前,各组H-B分级、FNFI评分比较,差异无统计学意义(P>0.05);术后<1个月组、1~2个月组H-B分级优于3~6个月组、>6个月组,且<1个月组优于1~2个月组,差异有统计学意义(P<0.05)。<1个月组术后3个月、6个月、1年分别康复5例、12例、18例,1~2个月组分别为3例、5例、12例,3~6个月组分别为0例、2例、5例,>6个月组分别为0例、1例、3例;<1个月组、1~2个月组术后1年康复率高于3~6个月组、>6个月组,且<1个月组高于1~2个月组,差异有统计学意义(P<0.05)。术后<1个月组、1~2个月组FNFI评分为(0.89±0.40)、(0.65±0.31)分,高于3~6个月组[(0.53±0.25)分]、>6个月组[(0.48±0.22)分],且<1个月组高于1~2个月组,差异有统计学意义(P<0.05)。结论外伤性面瘫患者于3个月内行面神经减压术的临床治愈率较高,其中<1个月为最佳手术时机,超过3个月的治愈率显著降低,预后越差。

Objective To study the effect of different operation timing on the prognosis of traumatic facial paralysis patients.Methods A total of 60 patients with traumatic facial paralysis who were admitted to the Department of Otolaryngology,Head and Neck Surgery of Tangdu Hospital of Air Force Military Medical University from February 2019 to October 2021 were retrospectively selected,divided into the<1 month group(n=18),the 1-2 month group(n=15),the 3-6 month group(n=16)and the>6 month group(n=11)according to different surgical opportunities to perform facial nerve decompression.House brackmann(H-B)facial nerve function rating scale was used to evaluate the facial nerve function and recovery rate of each group 1 year after operation,and the facial nerve function index(FNFI)score was evaluated.Results There was no statistically significant difference in H-B grade and fnfi score between the groups before operation(P>0.05);the H-B grades of the<1 month group and the 1-2 month group were better than those of the 3-6 month group and the>6 month group,and the<1 month group was better than that of the 1-2 month group,the difference was statistically significant(P<0.05).In the<1 month group,5 cases,12 cases and 18 cases recovered respectively at 3 months,6 months and 1 year after operation;in the 1-2 month group,3 cases,5 cases and 12 cases recovered respectively;in the 3-6 month group,0 cases,2 cases and 5 cases recovered respectively;in the>6 month group,0 cases,1 case and 3 cases recovered respectively;the recovery rate of 1 month group and 1-2 month group 1 year after operation was higher than that of 3-6 month group and>6 month group,and that of<1 month group was higher than that of 1-2 month group,the difference was statistically significant(P<0.05).The FNFI scores of the<1 month group and the 1-2 month group were(0.89±0.40)and(0.65±0.31)pionts,which were higher than those of the 3-6 month group[(0.53±0.25)pionts]and the>6 month group[(0.48±0.22)pionts],and those of the<1 month group were higher than those of the 1-2 month group,the differences were statistically significant(P<0.05).Conclusion The clinical cure rate of patients with traumatic facial paralysis who underwent facial nerve decompression within 3 months is higher,of which<1 month is the best time for operation,and the cure rate over 3 months is significantly reduced,and the prognosis is worse.