OBSERVATION ON CLINICAL THERAPEUTIC EFFECTS OF SCALP ACUPUNCTURE FOR FACIAL SPASM

Objective; To observe clinical therapeutic effect of scalp acupuncture in the treatment of facial spasm. Methods： Sixty-five cases of facial spasm were randomly divided into control group （n = 31 ） and treatment group（n = 34）. Patients of the treatment group were treated with penetrative acupuncture from Qienshencong（前神聪 Extra） to Xuanli（悬厘 GB 6）, Baihui（百会 GV 20） to Qubin（曲鬓 GB 7）, etc., and those of control group treated with acupuncture of Taiyang（太阳 EX-HN 5）, Yengbai（阳白 GB 14）, Quanliao（颧髎 SI 18） and Xiaguan（下关 ST 7）, etc. once daily, 20 sessions altogether. Results. After treatment, of the 31 cases and 34 cases in control and treatment groups, 5 and 12 were cured, 8 and 13 had remarkable improvement, 11 and 8 had improvement, 7 and 1 failed, with the total effective rates being 77.42% and 97.06% respectively; and the therapeutic elfact of treatment group was significantly superior to that of control group（P〈0.01）. Conclusion; Scalp acupurcture has an obvious therapeutic effect for facial spasm.

87 CASES OF FACIAL SPASM TREATED WITH MILD ACUPUNCTURE

Facial spasm is clinically a commonly en-countered and obstinate disease. This diseasewas treated by mild acupuncture with a satisfac-tory therapeutic effect, as summarized in thefollowing.GENERAL DATAThere were 87 cases in total in this series,52 males. and 35 females. The oldest and theyoungest patients were 60 and 28 years old re-spectively. The longest and the shortest

SHALLOW NEEDLING USED FOR THE TREATMENT OF 35 CASES OF FACIAL SPASM

In the present paper, the authors sum up results of acupuncture treatment of 35 cases of facial spasm. Of the 35 cases, 14 were male and 21 female, ranging in age from 19 to 62 years and in the disease duration from 1 week to 21 years. Shallow needling was applied to the surrounding region of Ahshi points (the twitching locus), Hegu (LI 4), Taichong (LR 3), etc., once daily, 4 weeks altogether. In addition, according to syndrome differentiation, other acupoints as Fengchi (GB 20), Waiguan (TE 5), Zusanli (ST 36), Sanyinjiao (SP 6), etc. were supplemented. After treatment, out of the 35 cases, 26 (74.3%) were cured, 5 (14.3%) experienced markedly improvement, and the rest 4 (11.4%) cases had a certain degree of amelioration. The key point for treating facial spasm is applying shallow needling around the twitching muscles.

Influence of distal portion compression of facial nerve in hemifacial spasm surgery

Objective To study influence of distal portion compression of facial nerve in hemifacial spasm surgery. Methods 120 hemifacial spasm patients were undergone lateral spread response monitoring during microvascular decompression surgery. 39 patients’LSR remained after decompression of the root exit zone of the facial nerve.

Intermittent facial spasms as the presenting sign of a recurrent pleomorphic adenoma

The intimate anatomical relationship of the facial nerve to the parotid parenchyma has a significant influence on the presenting signs and symptoms, diagnosis and treatment of parotid neoplasms.However, to our knowledge, hyperactivity of this nerve, presenting as facial spasm, has never been described as the presenting sign or symptom of a parotid malignancy.We report a case of carcinoma arising in a recurrent pleomorphic adenoma of the left parotid gland(i.e., carcinoma ex pleomorphic adenoma) that presented with hemifacial spasms.We outline the differential diagnosis of hemifacial spasm as well as a proposed pathophysiology.Facial paralysis, lymph node enlargement, skin involvement, and pain have all been associated with parotid malignancies.To date the development of facial spasm has not been reported with parotid malignancies.The most common etiologies for hemifacial spasm are vascular compression of the ipsilateral facial nerve at the cerebellopontine angle(termed primary or idiopathic)(62%), hereditary(2%), secondary to Bell's palsy or facial nerve injury(17%), and hemifacial spasm mimickers(psychogenic, tics, dystonia, myoclonus, myokymia, myorthythmia, and hemimasticatory spasm)(17%).Hemifacial spasm has not been reported in association with a malignant parotid tumor but must be considered in the differential diagnosis of this presenting symptom.

Treatment of 53 Cases of Facial Spasm with Acupuncture

Fifty-three patients with facial spasm were treated by acupuncture therapy. Taichong （LR 3）, Fengchi （GB 20）, Yifeng （TE 17）, and Sanyinjiao （SP 6） were selected as main points, and others points were selected based on symptom. Of the 53 cases, 9 cases were cured, 13 cases were markedly effective, 27 cases were effective, and 4 cases were ineffective, with an effective rate of 92.5%.

Therapeutic observation of superficial needling for hemifacial spasm

Objective： To observe the therapeutic efficacy of superficial needling in treating hemifacial spasm. Methods： Eighty patients with facial spasm were randomized into two groups by the random number table, 40 cases in each group. The observation group was intervened by superficial needling at local Ashi points and wrist-ankle acupuncture at the Upper 1, Upper 2 and Upper 3 points; while the control group was by ordinary acupuncture. For both groups, the treatment was given once a day, 7 times as a treatment course, and the therapeutic efficacy was evaluated after 3 courses. Results： The total effective rate and recovery rate were respectively 97.5% and 57.5% in the observation group versus 85.0% and 37.5% in the control group, and the differences were statistically significant （P〈0.05）. Conclusion： Superficial needling can produce a more significant efficacy in treating hemifacial spasm than ordinary acupuncture.

Clinical observation on acupuncture for 200 cases of facial spasm

Objective To explore the curative effect of acupuncture for facial spasm. Method Acupuncture treatment was adopted in 200 cases of patients with facial spasm, Sīzhúkōng （丝竹空 TE 23）, Hég （合谷 LI 4）, Tàichōng （太冲 LR 3）, Wàiguān （外关 TE 5）, Yánglíngquán （阳陵泉 GB 34） and Zhōngzh （中渚 TE 3） were selected. The needles were retained for 30 min, once a day, fifteen days as a treatment course. After 2 courses, the effect was assessed. Result One hundred and twenty-eight cases were cured, accounting for 64.0%; 49 cases had marked efficacy, accounting for 24.5%; 19 cases were improved, accounting for 9.5%; 4 cases were ineffective, accounting for 2.0%. Conclusion Smoothing the liver and activating the qi along with syndrome differentiation produces rapid and ideal curative effect in the acupuncture for facial spasm

陈婕基于整合针灸思维论治面瘫后面肌痉挛经验介绍

总结介绍陈婕主任基于符文彬教授整合针灸思维治疗面瘫后面肌痉挛的临床经验。陈婕主任指出面瘫后面肌痉挛属于中医经筋病范畴,其发生与正气不足、气血瘀滞、肝风内动及筋结既成有关,基于整合针灸思维以一松二温三灸方式治疗,针刀松解面部、颈部筋结点,配合温针、热敏灸阳明经、太阳经腧穴,以激发经气感传,使气至病所,发挥治疗作用。

基于3D Slicer的多模态影像融合技术及神经电生理监测在面肌痉挛微血管减压术中的应用

目的探讨基于3D Slicer的多模态影像融合技术及神经电生理监测在面肌痉挛微血管减压术中的应用价值。方法采用回顾性分析法,选取41例行血管减压术的面肌痉挛患者为研究对象。术前通过3D Slicer软件对责任血管进行多模态影像融合分析,确定手术方案,术中进行神经电生理监测以判断减压。观察手术效果并追踪术后复发情况。结果术前建模图像发现40例存在微血管压迫,1例未见微血管压迫。未见微血管压迫的1例经术中证实为岩静脉压迫,1例小脑前下动脉经术中证实为小脑上动脉,其余责任血管判定均与术中所见一致。术前建模图像的责任血管判定正确39例,正确率为95%。41例患者经手术治疗后症状均完全缓解,完全缓解率为100%。术后住院期间1例发生面瘫,1例发生听力下降,经对症处理后很快缓解,术后随访3~36个月无复发。结论在面肌痉挛微血管减压术中联合应用多模态影像融合技术可直观了解责任血管及周围重要结构解剖情况,配合神经电生理监测可避免术中减压过度或不充分的情况,两项技术的联合应用可有效提高手术疗效。

面肌痉挛显微血管减压术治疗分析

目的探讨显微血管减压术治疗面肌痉挛的手术方法及其临床疗效。方法回顾性分析2018年1月至2022年7月显微血管减压术治疗的187例面肌痉挛的临床资料。结果术中发现责任血管的构成:小脑前下动脉81例(43.3%),小脑后下动脉39例(20.9%),多根血管同时压迫67例(35.8%)。178例(95.2%)术后即刻症状完全消失,9例(4.8%)术后2周至3个月逐步消失。3例术后出现耳鸣,1个月后逐步恢复;1例出现听力丧失,未恢复;8例出现轻度面瘫,应用神经营养药物及结合局部针灸、高压氧治疗恢复;3例出现中度发热,静脉应用地塞米松3~5 d体温恢复正常;1例出现伤口脑脊液漏,经局部加压包扎等保守治疗愈合。术后无颅内感染、脑内出血等并发症,无手术死亡。结论显微血管减压术是治疗面肌痉挛的一种技术成熟的手术方法,术中熟练的显微外科操作,分清责任血管,做好术中监测,避免过分牵拉,是提高治愈率、减少并发症的关键。

陈以国教授针刺治疗面肌痉挛经验

面肌痉挛迁延难愈,大幅降低了患者的生存质量。陈以国教授从事临床、科研、教育工作数十年,临床经验丰富,治疗面肌痉挛疗效显著。陈教授认为面肌痉挛是本虚标实之证,以肝阴不足、肝气失疏而致肝亢失制为本,经筋失濡为标。肝亢失制,风气外现贯穿该病始终,整体表现为面肌异常之“动”。“肝木偏亢,经筋失养”为其病机关键。治疗当遵滋肝阴疏肝气、肺金承制肝木、熄风动濡经筋。故陈教授基于《内经》独创“陈氏吊针”,结合基于圆运动独创的“腹三针”,明辨病机,谨遵辨证以论治,借助共同作用调动肺脏、恢复肝脏和经筋的生理功能治疗该病。附验案一则,以资佐证。

三叉神经痛三例临床误诊分析

目的 分析三叉神经痛的临床特点及误诊原因,以减少误诊,提高诊断准确率。方法 回顾性分析2021年1月至2022年12月诊治的3例三叉神经痛误诊患者的临床资料。结果 1例女性患者右侧面部间断性剧烈疼痛半年,初步诊断为牙髓炎,多次接受牙科治疗但均无效,后经详细的病史采集和神经系统检查,发现其疼痛呈电击样,并结合神经系统检查和影像学检查结果,确诊为三叉神经痛。1例男性患者因左侧面部疼痛伴头痛2个月就诊,初步诊断为偏头痛,接受非甾体抗炎药和抗抑郁药治疗无效后经神经系统和影像学检查确诊为三叉神经痛。1例女性患者因左侧面部反复发作的电击样疼痛就诊,初步诊断为面肌痉挛,随后接受肉毒素局部注射等相关治疗,但效果不明显,后经神经系统和影像学检查确诊为三叉神经痛。误诊时间分别为6、2、3个月。确诊后均予卡马西平治疗,预后良好。结论 三叉神经痛初期误诊率较高,需提高临床医师对该病的认识,加强病史采集,必要时行相关的影像学等检查以提高诊断准确性。

多模式神经电生理监测在面肌痉挛MVD中的应用

目的探讨多模式神经电生理监测在面肌痉挛(HFS)显微血管减压术(MVD)中的应用效果。方法回顾性分析2020年12月至2022年3月MVD治疗的80例HFS的临床资料。术中应用异常肌电反应(AMR)、面神经运动诱发电位(FMEP)及自由肌电图(EMG)监测指导手术。结果术后1周治愈55例,明显缓解15例,部分缓解7例,无效3例;术后半年治愈57例,明显缓解10例,部分缓解9例,无效4例。术后1周治疗有效率为96.3%,术后半年治疗有效率为95.0%。术中AMR消失70例,存在10例;术中AMR消失病人术后1周(74.3%)、术后半年(78.6%)治愈率明显高于术中AMR存在的病人(分别为30.0%、20.0%;P<0.05)。80例术中均稳定引出FMEP,其中72例FMEP无变化;6例出现一过性波幅降低和(或)潜伏期延长,暂停手术操作后恢复;2例出现波幅降低且暂停手术操作无改善,术后出现面瘫。80例在分离和探查面神经REZ时均出现EMG不同程度的反应,其中一过性反应71例;持续出现的面神经爆发肌电图反应9例,暂停手术操作后缓解。结论术中AMR+FMEP+EMG多模式电生理监测技术对MVD判断责任血管、提高治愈率、保护面神经功能及避免并发症具有重要作用。

面肌痉挛微血管减压术前基于3D Slicer三维重建技术的可视化研究

目的对比术前3D Slicer三维重建技术判断面肌痉挛责任血管与微血管减压术中实际所见的一致性。方法纳入2018年7月至2024年1月在山东省东阿县人民医院行微血管减压术的62例面肌痉挛患者,术前均行三维稳态进动快速成像(3D-FIESTA)和三维时间飞跃(3D-TOF)MRA检查,通过3D Slicer软件将3D-FIESTA和3D-TOF MRA图像配准并进行三维重建以明确责任血管,以术中实际所见为“金标准”,对比术前三维重建与术中实际所见的一致性。结果共62例患者中61例经术前三维重建明确责任血管,分别为小脑前下动脉47例、小脑后下动脉6例、椎动脉5例、椎动脉联合小脑前下动脉2例、小脑上动脉1例;59例与术中实际所见责任血管一致,1例术前三维重建考虑为椎动脉压迫,术中证实为椎动脉联合小脑前下动脉压迫,1例术前三维重建考虑为小脑前下动脉压迫,术中证实为小脑前下动脉联合迷路动脉压迫,1例未发现明显责任血管,术中证实为小动脉压迫。术前三维重建判断责任血管的准确率为95.16%(59/62),经一致性检验,与术中实际所见的一致性较高(κ=0.886,P=0.000)。结论面肌痉挛患者微血管减压术前通过三维重建技术明确责任血管具有很高的准确性,有助于制定手术方案,为术中责任血管的判断提供依据。

不同针灸疗法治疗原发性面肌痉挛的网状Meta分析

目的:应用网状Meta分析法比较不同针灸疗法治疗HFS的疗效。方法:通过计算机检索中国知网、万方、维普等8个数据库从建库至2022年12月针灸治疗HFS的RCT,运用Cochrane 5.1.0偏倚风险评估工具进行质量评价,应用R4.2.2加载“gemtc”“rjags”程序包进行网状Meta统计分析。结果:纳入文献35篇,涉及16种干预措施,结局指标总有效率的SUCRA值从高到低的前3种干预措施为“放血+灸法”“埋针”“灸法”;Penn痉挛频率分级SUCRA值从高到低的前3种干预措施为“毫针+埋针”“针刀”“埋针”。结论:针灸疗法治疗HFS患者有一定的疗效优势,但在不同结局指标下,最佳的治疗方式可能有所区别,需要更多大样本、多中心的RCT对结果加以验证。

黄培新从虚、风、痰、瘀四维论治面瘫后面肌痉挛经验介绍

介绍黄培新教授从虚、风、痰、瘀四维论治面瘫后面肌痉挛的临床经验。黄培新教授认为,面肌痉挛病机为本虚标实,本虚为气血阴阳不足,久病耗损,筋失濡养;标实为风、痰、瘀相合,阻滞面络。病位主要与肺、脾、肝三脏有关;临证从虚、风、痰、瘀四维论治,以燮理肺肝脾三脏气机升降为期。以补虚祛邪、调和气血为治疗原则,扶正、祛风、活血、化痰有所侧重,灵活变通,随证治之,以平为期。

针灸治疗原发性面肌痉挛的临床研究进展

对近年来针灸治疗面肌痉挛的方法进行总结,认为普通针刺治疗,特色针灸疗法,包括温针灸、电针、灸法、耳穴、耳针、眼针、火针、埋针、埋线、小针刀,综合疗法,皆可在一定程度上缓解病情,疗效确切。同时针灸治疗原发性面肌痉挛也存在一定不足,在未来的研究中,应对针灸治疗面肌痉挛的机制进行深入研究,找寻最佳治疗方案,指导临床。

CT引导下经皮穿刺茎乳孔射频热凝治疗面肌痉挛护理分析

目的 探讨CT引导下行经皮穿刺茎乳孔射频热凝术治疗面肌痉挛的围术期护理。方法 回顾性分析行CT引导下经皮穿刺茎乳孔射频热凝术的32例面肌痉挛患者的临床资料,总结围术期护理。结果 本组患者术后面肌痉挛完全消失29例(90.6%),3例(9.4%)肉眼不可见抽动但有面肌抽动感觉。均遗留面瘫,随访3个月,于术后第2个月面瘫程度开始减轻。结论 绝大多数患者经过术前充分的沟通及宣教、术中要点动作的配合训练、完善术前准备,术中病情观察与心理护理以及术后饮食、体位与并发症的护理,面肌痉挛完全消失,效果满意。手术安全有效,是面肌痉挛治疗的有效新途径。

显微血管减压术中神经电生理监测对原发性面肌痉挛预后的影响

目的:分析显微血管减压术(MVD)中神经电生理监测对原发性面肌痉挛(HFS)预后的影响。方法:选取2020年10月—2023年10月阳光融和医院收治的原发性HFS患者60例为研究对象,随机分为对照组和观察组,各30例。对照组给予MVD手术治疗,观察组在对照组基础上给予术中神经电生理监测。比较两组临床疗效及并发症发生率。结果:两组治疗总有效率比较,差异无统计学意义(P>0.05);观察组术后并发症发生率低于对照组,差异有统计学意义(P=0.001);观察组术后复发率低于对照组,差异有统计学意义(P<0.001)。结论:MVD术后神经电生理监测治疗原发性HFS效果较好,能够降低术后并发症发生率及复发率。