改良耳后横切口与传统竖切口行微血管减压术治疗面肌痉挛的临床对比

Clinical comparison of modified postauricular transverse incision and traditional vertical incision for microvascular decompression in the treatment of hemifacial spasm

目的:分析改良耳后横切口与传统竖切口行微血管减压术治疗面肌痉挛的临床疗效比较。方法:采用前瞻性研究的方法,选择邯郸市中心医院2019年1月1日至2020年1月1日收治的116例面肌痉挛患者。依据入院的具体顺序将患者分成治疗组59例和对照组57例。对照组患者采用传统竖切口行微血管减压术治疗,治疗组患者采用改良耳后横切口行微血管减压术治疗。比较两组患者脑干听觉诱发电位(BAEP)、疼痛、手术指标、面容美观满意度和并发症。结果:治疗后两组患者潜伏期、波间期和波幅的BAEP较治疗前增加,且治疗组患者潜伏期、波间期和波幅BAEP均高于对照组[(1.89±0.19)ms比(1.62±0.21)ms、(7.89±0.15)ms比(6.25±0.41)ms、(1.79±0.19)ms比(1.54±0.11)ms](P<0.05)。治疗后两组患者视觉模拟评分(VAS)较治疗前下降,且治疗组患者VAS低于对照组[(1.15±0.27)分比(2.18±0.24)分](P<0.05)。治疗组患者手术时间、术中出血量和术后瘢痕长度均少于对照组[(60.41±3.81)h比(76.87±3.87)h、(30.18±4.19)ml比(56.87±4.15)ml和(4.18±1.07)cm比(6.87±1.05)cm](P<0.05)。治疗组患者面容美观满意率高于对照组[91.53%(54/59)比71.93%(41/57)](P<0.05)。治疗组患者并发症率低于对照组[5.08%(3/59)比21.05%(12/57)](P<0.05)。结论:采用改良耳后横切口行微血管减压术治疗面肌痉挛,能有效减少术中出血量和减轻术后瘢痕程度,增强脑干听觉诱发电位,提升美观性,疗效较好,建议使用。

Objective To compare the effect of modified postauricular transverse incision and traditional vertical incision for microvascular decompression in the treatment of hemifacial spasm.Methods Prospective study method was used.A total of 116 patients with hemifacial spasm in Handan Central Hospital from January 1,2019 to January 1,2020 were selected,and divided into two groups according to the admission order.Both groups underwent microvascular decompression;control group(57 cases)received traditional vertical incision,while treatment group(59 cases)received modified postauricular transverse incision.The brainstem auditory evoked potential(BAEP),pain degree,surgical indicators,facial aesthetic satisfaction and complications were compared between two groups.Results After treatment,the BAEP of latency,wave interval and wave amplitude in the two groups increased compared with that before treatment,and the BAEP of latency,wave interval and wave amplitude in the treatment group were higher than those in the control group:(1.89±0.15)ms vs.(1.62±0.21)ms,(7.89±0.15)ms vs.(6.25±0.41)ms,(1.79±0.19)ms vs.(1.54±0.11)ms(P<0.05).After treatment,the visual analogue score(VAS)of patients in the two groups decreased compared with that before treatment,and the VAS of patients in the treatment group was lower than that in the control group:(1.15±0.27)points vs.(2.18±0.24)points(P<0.05).The operation time,intraoperative bleeding volume and postoperative scar length of patients in the treatment group were less than those in the control group:(60.41±3.81)h vs.(76.87±3.87)h,(30.18±4.19)ml vs.(56.87±4.15)ml and(4.18±1.07)cm vs.(6.87±1.05)cm(P<0.05).The satisfaction rate of patients in the treatment group was higher than that in the control group:91.53%(54/59)vs.71.93%(41/57)(P<0.05).The complication rate of patients in the treatment group was lower than that in the control group:5.08%(3/59)vs.21.05%(12/57)(P<0.05).Conclusions Compared with traditional vertical incision,the modified transverse incision for microvascular decompression in the treatment of hemifacial spasm can reduce intraoperative blood loss and postoperative scar area,enhance brainstem auditory evoked potential,and improve facial aesthetics,which is worthy of recommendation.