经乳突面神经减压术治疗颞骨骨折致重度创伤性面瘫的临床疗效分析  

Analysis of clinical efficacy of transmastoid facial nerve decompression in the treatment of severe traumatic facial paralysis caused by temporal bone fracture

作　　者：李德志[1] 栗伟杰 王彬彬[2] 张幸楠 刘松[2] Li Dezhi;Li Weijie;Wang Binbin;Zhang Xingnan;Liu Song(Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Beijing Neurosurgical Institute,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院神经外科,北京100070 [2]首都医科大学,北京市神经外科研究所,北京100070

出　　处：《中华神经外科杂志》2022年第8期826-830,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81471239,82171364)。

摘　　要：目的:探讨经乳突面神经减压术治疗颞骨骨折致重度创伤性面瘫的手术疗效。方法:回顾性分析2016年1月至2017年9月首都医科大学附属北京天坛医院神经外科行经乳突面神经减压术治疗的24例因颞骨骨折致重度创伤性面瘫患者的临床资料。术前面神经功能House-Brackmann(H-B)分级Ⅵ级17例,Ⅴ级7例。所有患者均接受选择性经乳突面神经减压术,依据术前面神经损伤定位以及术中所见确定减压范围。术后1、3、6、12、18个月门诊随访面神经功能H-B分级,并行神经电生理检查。将术后面神经功能恢复至H-B分级Ⅰ、Ⅱ级定义为优,Ⅲ、Ⅳ级定义为良,Ⅴ、Ⅵ级定义为差。结果:术中可见面神经损伤位于膝状神经节至锥曲段,表现为神经水肿或卡压,1例为断裂伤。24例患者中,术中出现水平半规管局部破损3例,术后听力下降5例,听力丧失1例,外耳道皮肤破损2例。术后无一例脑脊液漏或感染等严重并发症发生。24例患者的随访时间为12~18(14.3±2.5)个月。至末次随访,24例患者中,H-B分级Ⅰ级3例,Ⅱ级16例,Ⅲ级4例,Ⅳ级1例;疗效优19例(79.2%),良5例(20.8%)。结论:采用经乳突面神经减压术治疗颞骨骨折致重度创伤性面瘫可有效促进面瘫的恢复,其有效性及安全性均较好。Objective To investigate the surgical efficacy of transmastoid facial nerve decompression in the treatment of severe traumatic facial paralysis caused by temporal bone fracture.Methods The clinical data of 24 patients with severe traumatic facial paralysis due to temporal bone fractures who underwent transmastoid facial nerve decompression in the Department of Neurosurgery,Beijing Tiantan Hospital,Capital Medical University from January 2016 to September 2017 were retrospectively analyzed.Preoperative assessment of facial nerve function using House-Brackmann(H-B)system indicated gradeⅥin 17 cases and gradeⅤin 7 cases.All patients underwent selective transmastoid facial nerve decompression,and the range of decompression was determined according to the location of nerve damage before surgery and intraoperative findings.At 1,3,6,12,and 18 months after the operation,the patients were followed up in outpatient clinic for H-B grading of facial nerve function,and nerve electrophysiological examination was performed.The postoperative recovery of facial nerve function to H-B gradesⅠandⅡwas defined as excellent,gradesⅢandⅣwere defined as good,and gradesⅤandⅥwere defined as poor.Results The injury was located between the geniculate ganglion and the pyramidal segment.Most cases had nerve edema and contusion.Facial nerve disruption was found in only 1 case.Among the 24 patients,3 had local damage in the horizontal semicircular canal during surgery,5 had postoperative hearing impairment,1 had hearing loss,and 2 reported skin damage in the external auditory canal.There were no serious complications such as cerebrospinal fluid leakage or infection.The follow-up time of 24 patients ranged from 12 to 18(14.3±2.5)months.At the last follow-up of 24 patients,there were 3 cases of H-B gradeⅠ,16 cases of gradeⅡ,4 cases of gradeⅢ,and 1 case of gradeⅣ.The therapeutic effect was excellent in 19 cases(79.2%)and good in 5 cases(20.8%).Conclusion Transmastoid facial nerve decompre-ssion in the treatment of severe tra

关 键 词：面神经损伤 创伤 神经系统 颞骨 减压术 外科 治疗结果 

分 类 号：R683.5[医药卫生—骨科学]