完全性贝尔麻痹减压术后1周面肌随意动作及电生理数据恢复的意义  

Significance of facial voluntary movements and recuperation of electrophysiologic outcomes in the first week after decompression in the total Bell Palsy

作　　者：李健东[1] 赵亮[1] 刘苏辐[1] 白云波[1] 汪学勇[1] 

机构地区：[1]北京世纪坛医院面神经研究室,北京市100038

出　　处：《中国临床康复》2005年第45期11-13,共3页Chinese Journal of Clinical Rehabilitation

基　　金：首都医学发展科研基金资助项目(2002-3066)~~

摘　　要：目的:通过对接受减压术的完全性贝尔麻痹患者手术前后进行的电生理观察,证实完全性面神经麻痹患者的面神经不是完全变性,可能残存一部分传导阻滞的纤维。方法:选择2005-03/06北京世纪坛医院面神经研究室收治的31例单侧完全性贝尔麻痹患者,平均病程97.3d,所有患者House-Brackmann分级(Ⅰ～Ⅵ级,评级越高,面神经麻痹程度越重)均为Ⅵ级,并接受了经乳突颞下入路面神经减压术。术前检测双侧降口角肌的动作电位和F波,比较振幅和时程,术后第7天复查,比较手术前后动作电位的参数变化,并评定House-Brackmann分级。结果:31例患者全部进入结果分析。①患侧动作电位:术前26例检测到,术后均检测到,术后平均振幅较术前显著增高[(324.73±384.02),(94.48±88.15)μV,P<0.01];术后平均时程较术前显著长[(11.64±7.86),(4.10±3.08)ms,P<0.01]。②F波:术前均未引出,术后3例(10%)引出。③术后7d内87%的患者(27例)出现运动恢复,22例患者达到House-BrackmannⅤ级,5例患者达到House-BrackmannⅣ级。结论:①完全性面神经麻痹不等同于全部面神经纤维变性,大多数患者仍然残存着相当数量的传导阻滞的纤维,不能随便认定患者的面神经纤维100%变性。②F波消失的患者预后差,保守治疗无效,及时的面神经减压术能够有效解除传导阻滞,从而表现出术后早期的临床恢复过程。③术后早期评价面神经功能恢复程度时,肌电图随意动作电位比F波更加敏感。AIM： To verify that facial nerve of patients with complete facial paralysis is not complete degeneration, may existing a part of the conduction block fibers in facial nerve after the electrophysiological observation in patients with complete Bell palsy that accepted the decompression before and after operation. METHODS： Thirty-one unilateral total Bell palsy patients, who were treated at the Facial Nerve Research Room, Beijing Shijitan Hospital from March to June 2005, were selected. Mean progress was 97.3 days. All the patients were classified by House-Braekmann （Ⅰ-Ⅵ grades, the higher the grade, the more severe of level of facial paralysis was.）, and they were all Ⅵ grade, and all treated with facial nerve decompression through mastoid subtemporal approach. Action potential and F wave at the bilateral depressor anguli oris muscle were detected before operation. Amplitude of vibration and duration were compared. Re-examination was performed at the 7^th day after operation. Changes of parameter of action potential before and after operation were compared. The House-Brackmann grading was assessed： RESULTS： Thirty-one patients were all involved in the result analysis. ① Action potential of the injured side： It was found in 26 cases before operation, and in all the cases after operation. The mean amplitude of vibration after operation increased significantly than that before operation [（324.73±384.02 ）, （94.48±88.15 ）μV, P 〈 0.01 ]. Mean duration after operation became rapidly obviously than that before operation [ （11.64±7.86 ）, （ 4.10±3.08 ） ms, P〈0.01]. ② F wave： There was no F wave before operation, while it appeared in 3 cases （10%） after operation.③ In the first 7 days after operation, 27 of 31 （87%） patients had the visible voluntary movements of facial muscle. Twenty-two patients reached House-Brackmann Ⅴ grade, and 5 patients reached House-BrackmannⅣ grade. CONCLUSION： ① Total facial paralysis is not equal to total facial fiber degenerat

关 键 词：Bell麻痹 减压术 外科 动作电位 神经传导阻滞 神经变性 

分 类 号：R745.12[医药卫生—神经病学与精神病学]