面瘫患者咬肌神经-面神经转位联合阔筋膜静态悬吊术后静态对称性的评估  

Evaluation of static symmetry in patients with facial paralysis after masseteric-to-facial nerve transfer combined with fascia lata graft

作　　者：周宇璐 马昊 文辉才[2] 王炜[1] Zhou Yulu;Ma Hao;Wen Huicai;Wang Wei(Department of Plastic and Reconstructive Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Plastic Surgery,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]上海交通大学医学院附属第九人民医院整复外科,上海200011 [2]南昌大学第一附属医院整形美容科,南昌330006

出　　处：《中华整形外科杂志》2022年第9期1013-1021,共9页Chinese Journal of Plastic Surgery

基　　金：上海市科委自然科学基金(18411961800)。

摘　　要：目的评估应用咬肌神经-面神经转位联合阔筋膜静态悬吊术治疗早期完全性面瘫后的静态对称性效果。方法回顾性分析2016年1月至2018年12月于上海交通大学医学院附属第九人民医院整复外科应用咬肌神经-面神经转位联合阔筋膜静态悬吊术修复早期完全性面瘫患者的临床资料。根据术前静态口角歪斜程度(即口角静态对称性)将患者分为2组,口角轻度不对称(Ⅱ级)为A组,重度不对称(Ⅲ级)为B组。在术前和术后1年随访时,通过Terzis微笑功能评级量表评估患者面部肌肉收缩活动情况,分为Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级,级别越高,面部肌肉收缩越好,与健侧面部肌肉动态对称性越好;通过口角静态对称性评级量表评估患者口角静态对称性,分为Ⅰ、Ⅱ、Ⅲ、Ⅳ级,级别越高对称性越差;通过Face-gram软件测量健侧和患侧口角位置垂直向差值(D_(1))和水平向差值(D_(2)),客观评估术后面部静态对称性效果。应用SPSS 26.0软件进行统计分析,计数资料比较采用卡方检验,计量资料组间比较采用两独立样本t检验,组内比较采用配对样本t检验,P<0.05表示差异有统计学意义。结果共纳入58例患者,其中A组30例,男12例,女18例,年龄(43.5±8.1)岁;B组28例,男12例,女16例,年龄(40.6±9.6)岁。2组在性别、年龄、瘫痪侧构成、瘫痪时间等方面差异无统计学意义(P>0.05)。A、B 2组患者术前Terzis微笑功能评估均为Ⅰ级,术后1年A组中有30.%(9/30)达Ⅲ级,70.0%(21/30)达Ⅳ级,B组中35.7%(10/28)达Ⅲ级,64.3%(18/28)达Ⅳ级,2组微笑功能均比术前明显改善,且组间微笑功能改善程度比较,差异无统计学意义(P>0.05)。口角静态对称性评分量表显示,术后1年A组中有73.3%(22/30)口角静态对称性评分达到Ⅰ级,26.7%(8/30)仍为Ⅱ级;B组中有39.3%(11/28)达Ⅰ级,42.9%(12/28)达Ⅱ级,17.8%(5/28)仍为Ⅲ级。A组达到面部静态对称效果(Ⅰ级)的比例较B组高(P<0.01)。术前和Objective To evaluate the static symmetry in patients with early facial paralysis after masseteric-to-facial nerve transfer combined with fascia lata graft.Methods Clinical data of paralyzed patients who treated with masseteric-to-facial nerve transfer combined with fascia lata graft in Shanghai Jiao Tong University School of Medicine Affiliated Ninth People’s Hospital from January 2016 to December 2018 were retrospectively analyzed.Patients were divided into two groups according to the degree of preoperative oral commissure dropping:slight asymmetry(ScaleⅡ,Group A)and severe asymmetry(ScaleⅢ,Group B).Facial muscle contraction was evaluated by Terzis Facial Grading System to evaluate smile function,which was divided into ScoreⅠ,Ⅱ,Ⅲ,ⅣandⅤ.The higher the score,the better the facial muscle contraction and the better the dynamic symmetry during preoperatively and one year postoperatively.The static symmetry of oral commissure was evaluated by Symmetry Scale of Oral Commissure to evaluate symmetry at rest,which was divided into ScaleⅠ,Ⅱ,ⅢandⅣ,the higher the scale,the worse the static symmetry.Face-gram software was adopted to measure bilateral vertical differences(D_(1))or horizontal differences(D_(2))in the oral commissure position of the patients with facial paralysis for evaluating the postoperative static symmetry objectively.Statistical analyses were performed with SPSS version 26.0.Numeration data were analyzed by chi-square test.Intragroup quantitative data was analyzed by paired t-test and intergroup quantitative data was analyzed by two-sample t-test.The significance level was set at 0.05.Results A total of 58 patients were included,including 30 patients in group A[male 12,female 18,age(43.5±8.1)years],and 28 patients in group B[male 12,female 16,age(40.6±9.6)years].There was no significant difference in sex,age at surgery,paralyzed side and denervation time between groups(P>0.05).The patients were scoredⅠon Terzis’smile functional evaluation scale preoperatively.The score of smi

关 键 词：面瘫 静态对称性 神经转位 咬肌神经 静态悬吊术 

分 类 号：R745.12[医药卫生—神经病学与精神病学]