电生理监测下改良Foerster-Dandy手术治疗痉挛性斜颈初探  

Preliminary exploration of modified Foerster-Dandy's operation for the treatment of spasmodic torticollis with intraoperative neurophysiolgical monitoring

作　　者：高进喜[1] 郑兆聪[1] 陈乃洁[1] 陈渊[1] 王守森[1] 

机构地区：[1]南京军区福州总医院神经外科,福州350025

出　　处：《立体定向和功能性神经外科杂志》2011年第5期263-265,共3页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的探讨电生理监测下改良Foerster-Dandy手术治疗痉挛性斜颈的安全性和疗效。方法前瞻性研究2010年11月至2011年7月显微手术治疗的7例痉挛性斜颈病人,全部采用电生理监测下改良Foerster-Dandy手术,手术方法为枕后正中入路硬膜下双侧副神经根、C1脊神经根切断、C2-4脊神经前、后根选择性部分切断术。结果全部病人术后立即感到痉挛状态明显缓解,随访期间缓解率为85.7%(6/7),生活质量提高率在随访期间为85.7%,术后6例发生不同程度转颈无力、耸肩无力,随访期间均有所好转,无吞咽困难和头颈部支撑困难病例,无严重并发症发生。随访期间1例斜颈复发,使用盐酸度洛西汀+苯海索治疗后症状显著改善。结论电生理监测下改良Foerster-Dandy手术治疗痉挛性斜颈安全有效,熟悉局部解剖、掌握显微手术技巧是手术安全的基础;选择合适的病例、合理使用电生理监测技术、个体化制定神经根选择性切断的程度是手术疗效的保证。本研究只是改良Foerster-Dandy手术治疗痉挛性斜颈的初步探索,该术式大宗病例和长期随访资料尚需进一步积累完备。Objective To observe the safety and effectiveness of modified Foerster-Dandy＇s operation for the treatment of spasmodic torticollis with intraoperative neurophysiolgical monitoring.Methods Seven cases of spasmodic torticollis patients from November 2010 to July 2011 were studied prospectively.All the patients were treated by microsurgical modified Foerster-Dandy ＇s operation with intraoperative neurophysiolgical monitoring.Selective neurotomy of bilateral accessory nerves,C1 spinal nerve,C2-4 ventral roots and dorsal roots was performed.Results Our study showed that all patients experienced disappearance or notable regression of the spasticity rightly after operation,and the percentage in follow-up duration was 85.7%,and 85.7% cases had a better life quality.Postoperative complications included muscle weakness of neck and shoulder（85.7%）.No severe complication occured.There was one recurrence case during the follow-up duration,but curred by the duloxetine and trihexyphenidyl.Conclusion Modified Foerster-Dandy ＇s operation with intraoperative neurophysiolgical monitoring is an effective microsurgical method for the treatment of spasmodic torticollis.The proper choice of cases,understanding of regional microanatomy,skilled microsurgical techniques are the keys to gain good effects.This study is only a Preliminary exploration of the treatment of spasmodic torticollis,more cases and long follow-up duration are needed to effort.

关 键 词：痉挛性斜颈 改良Foerster-Dandy手术 电生理监测 并发症 

分 类 号：R746[医药卫生—神经病学与精神病学]