痉挛性斜颈的临床分型和手术治疗  

Clinical classification and surgical treatment of spasmodic torticollis

作　　者：姬绍先[1] 陈信康[1] 周国俊[1] 马安保[1] 梁健[1] 熊左隽[1] 裴圣广[1] 

机构地区：[1]武汉市中心医院(武汉市第二医院)神经外科,430014

出　　处：《立体定向和功能性神经外科杂志》2004年第6期341-344,共4页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的　研究痉挛性斜颈 (spasmodictorticollis,ST)临床分型和手术治疗关系。方法　对ST按痉挛肌肉范围分型 :单纯性ST和症状性ST。按姿态分型 :旋转型、侧屈型、后仰型、前屈型和混合型ST。按肌肉痉挛的方式分型 :强直型和阵挛型ST。按病情程度分型 :轻型和重型。手术治疗 :针对ST姿态分型采用不同术式组合。对旋转型ST ,采用二联术或三联术 ,(术式一 :面部旋向侧颈后痉挛肌肉选择性切除术或部分切除术。术式二 :同侧颈神经 1～ 6 (C1～ 6)后支选择性切断术。术式三 :对侧副神经切断术或加胸锁乳突肌切除术。三种术式合用称“三联术”。术式一和三合用称“二联术”)。侧屈型ST采用屈向侧二联术或三联术。后仰型ST采用双侧术式一或术式一和术式二合用。前屈型ST采用双侧术式三。混合型ST采用分期颈部神经选择性切断术和肌肉选择性切除术。结果　术后 6个月评定疗效 ,全组 5 95例 ,斜颈症状消失 4 0 4例 (6 8% ) ,显效 10 7例 (18% ) ,进步 6 7例 (11.1% ) ,无效 17例 (2 .9% )。无死亡和严重并发症。结论　采用颈部痉挛肌肉选择性切除和颈部神经选择性切断术治疗ST ,手术安全创伤小、操作简便 ,无残疾并发症。头部CT和MR检查未发现与痉挛性斜颈有关的颅内病灶。颈部CT显示痉挛肌肉呈肥大性改变。Objective To study the clinical classification and surgical treatment of spasmodic torticollis (ST).Methods The classification according to the pose of torticollis:Rotational ST (ROST),Lateral flexional ST (LFST),Anteflexional ST (AFST),Retroflexional ST (REST) and Complicated ST (COST);According to the range of spasmodic muscles:primary ST and symptomatic ST;Accoding to the mode of the spasmodic muscles:stiffness ST and clonus ST;According to the extent of symptoms:slight ST and serious ST.Surgical treatment:The operative mode was depended on the pose of ST.The mode1,2,3 or their combination.Mode 1:Selective resection of posterior cervical spasmodic muscles.Mode2:Selective neurotomy of posterior branches of cervical nerve 1～6.Mode 3:Comtialatearal accessory neurotomy.The combination of mode 1,2 and 3 is called the triad procedure,the combination of mode 1 and 3 is called the biad procedure.The triad and biad procedures were used for ROST and LFST,bilateral mode 1 and mode 2 for REST,bilateral mode 3 for AFST,mode 1,2 and 3 for COST at different phase.Results The evaluation of clinical effects over 6 months postoperation:Total 595 cases,404 were recovered(68%),107 were markly effective(18%),67 were progress(11.1%),17 were inefficiency(2.9%).Conclusion The surgical treatment of selective resection of cervical spasmodic muscles and selective neurotomy of cervical nerve for ST is safe and effective.The films of head CT and MRI scan in this group was normal.The neck CT scan shows that the spasmodic muscles become swollen.EMG showed entire or partial interferent waves in the spasmodic muscles.The pathologic section of resected muscles and nerves showed abnormal.The clinical data in our patients have provided us the important informations for further researching on the pathogenesis of ST.

关 键 词：痉挛性斜颈 外科手术 副神经 选择性肌肉切除术 

分 类 号：R744.9[医药卫生—神经病学与精神病学]