垂直段損傷面神經(jīng)減壓術(shù)式選擇

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1、垂直段損傷面神經(jīng)減壓術(shù)式選擇【摘要】　　目的：探討面神經(jīng)全段減壓術(shù)和垂直段減壓術(shù)治療面神經(jīng)垂直段損傷所致周圍性面癱療效。方法:按House和Brackmann評(píng)分法對(duì)63例面神經(jīng)垂直段損傷致面癱患者進(jìn)行術(shù)前、術(shù)后的面神經(jīng)功能評(píng)估。所有患者皆行耳后切口，26例經(jīng)乳突一上鼓室進(jìn)路全段面神經(jīng)減壓術(shù)；28例僅行垂直段面神經(jīng)減壓術(shù)；5例行面神經(jīng)端端吻合術(shù)；4例行面神經(jīng)移植術(shù)。結(jié)果:術(shù)后1年評(píng)估：垂直段減壓術(shù)28例，Ⅰ級(jí)恢復(fù)者11例，Ⅱ級(jí)恢復(fù)者10例，Ⅲ級(jí)恢復(fù)者7例。全段減壓術(shù)26例，Ⅰ級(jí)恢復(fù)者9例，Ⅱ級(jí)恢復(fù)者11例，Ⅲ級(jí)恢復(fù)者6例。兩者比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P>0.05)。術(shù)后面神經(jīng)功能恢復(fù)程度與

2、病程有密切的正相關(guān)關(guān)系。面神經(jīng)吻合和移植術(shù)后，面神經(jīng)功能恢復(fù)多不理想。結(jié)論:垂直段面神經(jīng)損傷性面癱，術(shù)后功能恢復(fù)與減壓術(shù)式無(wú)明顯關(guān)系，而與病程和損傷程度有關(guān)?！娟P(guān)鍵詞】垂直段面神經(jīng)；損傷；減壓術(shù)　?。跘BSTRACT］Objective:Toinvestigatetheeffectsofwholefacialnervedecompressionandverticalsegmentoffacialnervedecompressiononperipheralfacialparalysiscausedbyverticalsegmentoffacialnerveinjuries.Methods:Fun

3、ctionoffacialneverin63patientswithverticalsegmentoffacialnerveinjuriespreandpostoperationwereevaluatedwithHouseand11Brackmannscales.Twentysixcasesunderwentwholefacialnervedecompressionbymastoidatticapproach,28underwentverticalsegmentoffacialnervedecompression,5underwentfacialnerveanastomosis,and4un

4、derwentfacialnervetransplantation.Result:Assessmentoffacialnervefunctiononeyearaftertheoperationshowed:11ofthe28casesthatunderwentverticalsegmentoffacialnervedecompressionwereevaluatedasgradeⅠremission,10asgradeⅡremissionand7asgradeⅢ,9ofthe26patientsthatunderwentverticalsegmentoffacialnervedecompres

5、sionwereevaluatedasgradeⅠremission,11asgradeⅡ,and6asgradeⅢ,showingnosignificantdifferencebetweenthe2groups.However,theremissiondegreewascorrelatedwiththediseasecourse.Forthoseunderwentfacialnervetransplantationhaven'tobtainedsatisfactoryfacialnervefunction.Conclusions:Forperipheralfacialparalysiscau

6、sedbyverticalsegmentoffacialnerveinjuries,postoperativerecoverystatuswasnotcorrelatedwithdecompressionmethod,butwiththeinjuryseverityanddiseasecourse.　?。跭EYWORDS］Verticalsegmentoffacialnerve;Injury;Decompression11　　頭面部外傷、顳骨內(nèi)疾病可引起面神經(jīng)損傷，導(dǎo)致完全性或不完全性面癱，其中顳骨骨折是面神經(jīng)損傷最為常見(jiàn)的致病原因［1］，各類中耳乳突手術(shù)所致醫(yī)源性面癱亦偶有所見(jiàn)。面神經(jīng)損傷按

7、部位可分為顱外段、顳骨內(nèi)段和顱內(nèi)段，按外傷類型又可分為穿透性、閉合性或醫(yī)源性。對(duì)顳骨骨折或醫(yī)源性引起者，多主張手術(shù)探查。我科1989年3月～2009年3月分別采用面神經(jīng)全段減壓術(shù)和垂直段減壓術(shù)治療面神經(jīng)垂直段損傷致面癱63例，取得了較好的臨床效果，現(xiàn)報(bào)道如下?！　?資料與方法　　1.1一般資料　　本組患者63例，男性49例，女性14例。年齡15～53歲，平均28歲。左側(cè)面癱34例，右側(cè)面癱29例。