失神经支配程度测试在判断面神经功能恢复中的作用

Effect of denervation degree test on the estimation of neurologic functional recovery in facial paralysis rehabilitation

目的:探讨面神经不同失神经支配程度的病理变化对面神经功能康复的影响。方法:应用神经兴奋性测试仪测试正常人双侧面神经兴奋阈值的差值,进行重复性实验。测试面神经麻痹(facialparalysis,FP)者面神经的失神经支配程度。制作豚鼠颞骨内FP模型,应用诱发肌电图测试压榨面神经前后动作电位的反应阈值及通过瞬目反射观察面肌功能恢复时间。透射电镜观察面神经的病理改变。结果:190例FP由恢复到临床治愈,失神经支配阴性组需(33.1±21.3)d;失神经支配I度组需(63.3±12.4)d;失神经支配Ⅱ度组需(90.1±11.7)d;失神经支配III度组需(210.2±37.5)d,4组间差异有显著性意义(t=2.676～3.973,P<0.01)。压迫面神经5s组,神经兴奋性传导恢复时间和瞬目反射恢复时间都是(60.7±45.3)h;15s组神经兴奋性传导恢复时间(982.6±36.6)h,瞬目反射恢复需(46±12)d;30s组神经兴奋性传导和瞬目反射无一只恢复到正常。电镜观察5s组髓鞘板层轻度松散,15s组髓鞘板层重度松散,30s组髓鞘融解轴突破坏。结论:失神经支配程度是FP康复诊断的指标,并与髓鞘和轴突破坏程度有关。

AIM:To explore the effect of pathologic change of different denervation degree of facial nerve on its functional rehabilitation. METHODS:The difference of threshold excitation of bilateral facial nerve of normal individuals was detected by nerve excitability tester,and the experiment was repeated.The denervation degree of subjects with facial paralysis (FP) was measured.Guinea pig model of FP in temporal bone was made.The liminal value of response of action potential before and after the facial nerve was squeezed was measured with evoked electromyography (EEMG),and the duration of the functional recovery of facial nerve was observed through blink reflex.The pathologic change of facial nerve was observed with transmission electron microscope (TEM). RESULTS:One hundred and ninety cases were applied. The period from recovery to cure in the denervation negative group was(33.1±21.3) d,and(63.3±12.4) d in the denervation degree group I,(90.1±11.7) d in the denervation degree group II;(210.2±37.5)d in the denervation degree group III.There was a significant difference among the four groups(t=2.676-3.973,P< 0.01).In the group with compressing teat of the facial nerve for 5 seconds, the recovery period of nerve excitability conduction and blink reflex was (60.75±45.3)h.In the group with compressing for 15 seconds was(982.6±36.6) h to recover nerve excitability conduction and(46±12) d to recover the blink reflex. The nerve excitability and blinkreflex could not be restored in 30 seconds group.Mild separation of myelin sheath was observed in 5 seconds group and severe separation in 15 seconds group, destruction of myelin sheath and axon was observed in 30 seconds group. CONCLUSION:The degree of denervation is a marker for rehabilitative diagnosis of FP, and is related to the destruction degree of myelin sheath and axon.