面肌痉挛患者行显微血管减压术后发生严重听力障碍的危险因素分析  

Risk factors for severe hearing impairment after microvascular decompression for treatment of hemifacial spasm

作　　者：刘学来[1] 曲新娟[1] 刘向东[1] 刘永博[1] 杨培中[1] 宋振宇 王振国 张黎[2] Liu Xuelai;Qu Xinjuan;Liu Xiangdong;Liu Yongbo;Yang Peizhong;Song Zhenyu;Wang Zhenguo;Zhang Li(Department of Neurosurgery,Linyi Hospital of Traditional Chinese Medicine,Linyi 276002,China;Department of Neurosurgery,China-Japan Friendship Hospital,National Health Commission,Beijing 100020,China)

机构地区：[1]临沂市中医医院神经外科,276002 [2]国家卫健委中日友好医院神经外科,北京100020

出　　处：《中华神经医学杂志》2021年第8期821-826,共6页Chinese Journal of Neuromedicine

摘　　要：目的研究原发性面肌痉挛(HFS)患者行显微血管减压术(MVD)后患侧发生严重听力障碍的危险因素。方法选择临沂市中医医院和国家卫健委中日友好医院神经外科自2007年10月至2020年8月采用MVD术治疗的3700例HFS患者,按术后是否出现患侧严重听力障碍,将患者分为严重听力障碍组和无严重听力障碍组。比较2组患者的临床资料,多重线性回归分析确定患者术后发生患侧严重听力障碍的独立影响因素。结果术后出现患侧严重听力障碍45例(1.2%),随访0.6~11.8年(平均6.3年),无一例恢复。与无严重听力障碍组比较,严重听力障碍组患者的年龄较大,男性、左侧HFS、合并高血压、糖尿病者所占比例较高,后颅窝容积狭小、蛛网膜增厚黏连者所占比例较高,责任血管为椎动脉(VA)者所占比例较高,责任血管为小脑前下动脉者所占比例较低,责任动脉硬化、困难减压者所占比例较高,差异均有统计学意义(P<0.05)。多重线性回归分析结果显示合并高血压、责任血管为VA、责任动脉硬化、困难减压是HFS患者行MVD术后发生患侧严重听力障碍的独立危险因素(P<0.05)。结论HFS患者行MVD术后患侧严重听力障碍一旦发生很难恢复。术前有高血压、责任血管为VA、责任动脉硬化、困难减压的HFS患者MVD术后易发生患侧严重听力障碍。Objective To study the risk factors for ipsilateral severe hearing impairment in patients with hemifacial spasm(HFS)after microvascular decompression(MVD).Methods MVD was performed in 3700 patients with HFS,admitted to our hospital from October 2007 to August 2020;according to the existence of ipsilateral severe hearing impairment,these patients were divided into severe hearing impairment group and non-severe hearing impairment group.The clinical data of these patients were compared.Multivariate linear regression analysis was used to determine the independent influencing factors for ipsilateral severe hearing impairment.Results Forty-five patients(1.2%)had ipsilateral severe hearing impairment after MVD;no one got recovery of hearing impairment during the follow-up period(0.6-11.8 years,6.3 years in average).As compared with those in the non-severe hearing impairment group,patients in the severe hearing impairment group had significantly older age,significantly higher percentages of male patients,and patients with left HFS,hypertension,and diabetes mellitus,statistically higher percentage of patients having small posterior fossa volume,arachnoid thickening and adhesion,and vertebral artery compression,significantly lower percentage of patients with anterior inferior cerebellar artery compression,significantly higher percentage of patients with arteriosclerosis of offending arteries and difficult decompression(P<0.05).Multivariate linear regression analysis revealed that hypertension,vertebral artery compression,arteriosclerosis of offending artery and difficult decompression were independent risk factors for severe hearing impairment in patients with HFS after MVD.Conclusion It's difficult to get recovery for severe hearing impairment in patients with HFS after MVD;this complication is much common in patients with hypertension,vertebral artery compression,arteriosclerosis of offending artery or difficult decompression.

关 键 词：面肌痉挛 显微血管减压术 听力障碍 

分 类 号：R651.3[医药卫生—外科学]