微侵袭手术治疗侧屈型痉挛性斜颈81例  

Minimally invasive neurosurgery for lateroflexion spasmodic torticollis (a report of 81 cases)

作　　者：姬绍先[1] 马安保[1] 梁健[1] 王雷[1] 熊左俊[1] 王璐[1] 何苗[1] 欧阳九鸿[2] 

机构地区：[1]武汉市中心医院神经外科,430014 [2]武汉市中心医院神经外科病案统计科,430014

出　　处：《中国临床神经外科杂志》2010年第7期393-395,399,共4页Chinese Journal of Clinical Neurosurgery

摘　　要：目的研究侧屈型痉挛性斜颈(LFST)微侵袭手术治疗效果。方法将LFST相关的痉挛肌肉分成主要责任肌和次要责任肌,并明确每一肌肉的支配神经。对LFST临床分型,按不同分型制定个体手术方案。采用下列术式组合治疗。术式1:屈向侧颈痉挛肌肉选择性切除术。术式2:屈向侧颈神经1～6后支选择性切断术。术式3:屈向侧副神经切断术(或附加胸锁乳突肌、斜角肌切除术)。三种术式组合称"三联术",术式1和术式3组合称"二联术"。结果术后6～12个月评定疗效,全组81例痊愈69例(85.2%),显效8例(9.9%),进步4例(4.9%),无死亡和严重并发症。35例采用二联术治疗的患者中,痊愈27例,显效5例,进步3例,优良率91.4%(32/35);46例采用三联术治疗患者中,痊愈42例,显效3例,进步1例,优良率97.8%(45/46)。结论采用颈部痉挛肌肉选择性切除和相关神经选择性切断术治疗LFST,手术安全创伤小,效果满意。Objective To study the technique of minimally invasive neurosurgery for laterofexion spasmodic torticollis（LFST）.Methods The muscles related to LFST were divided into main responsible muscles and secondary responsible muscles for LFST in 81 patients with LFST.The nerves which controlled each responsible muscle were made to be understood.The individualized operative mode was made according to the pose and direction of LFST.Mode 1 was selective resection of the spasmodic muscles in the flexure side.Mode 2 was selective neurotomy of posterior branches of cervical nerves 1～6 in the flexure side.Mode 3 was neurotomy of the accessory nerve in the flexure side.The combination of modes 1,2 and 3 was called the triad procedure.The combination of modes 1 and 3 was called the bigeminal procedure.Results The curative effect was evaluated 6 to 12 months after the operation.The clinical symptom disappeared in 69 patients（85.2%）.There were significantly curative effects in 8 patients（9.9%）.The clinical symptom was improved in 4 patients.No patients died and these were no severe complication in all the patients.Conclusion The selective resection of cervical spasmodic muscles and selective denervation of muscles relate to LFST is safe and effective method to treat LFST.

关 键 词：侧屈型痉挛性斜颈 微侵袭手术治疗 肌切除术 神经切断术 应用解剖 

分 类 号：R653[医药卫生—外科学] R682.12[医药卫生—临床医学]