颞浅动脉-大脑中动脉搭桥与颞肌贴覆治疗缺血性烟雾病术后颞肌血运及并发症的比较  

Comparison of superficial temporal artery-middle cerebral artery bypass with temporal muscle patch in the treatment of postoperative temporal muscle haemodynamics and complications in ischaemic smouldering disease

作　　者：韩莹[1] 吴磊[1] 陈兴河[1] 冯三平[1] 王永恒[1] 韩志光[1] 赵锦程[1] 李起超[1] 赵建华[1] 冯继[1] HAN Ying;WU Lei;CHEN Xinghe;FENG Sanping;WANG Yongheng;HAN Zhiguang;ZHAO Jincheng;LI Qichao;ZHAO Jianhua;FENG Ji(The First Hospital of Qinhuangdao,Qinhuangdao 066000,China)

机构地区：[1]秦皇岛市第一医院,河北秦皇岛066000

出　　处：《中国实用神经疾病杂志》2024年第5期589-594,共6页Chinese Journal of Practical Nervous Diseases

基　　金：秦皇岛市市级科技计划(第三批)项目(编号:201703A071)。

摘　　要：目的 比较颞浅动脉-大脑中动脉搭桥与颞肌贴覆术对成年缺血性烟雾病(MMD)患者神经功能和脑血流的改善作用,以及对颞肌血运、术后相关并发症的影响。方法 以2020-09—2022-12秦皇岛市第一医院收治的39例MMD患者为研究对象,其中单纯实施颞肌贴覆术20例为对照组,实施颞浅动脉-大脑中动脉搭桥术19例为研究组。采用改良Rankin量表(mRS)比较2组患者治疗前后神经功能恢复情况,采用经颅多普勒检测2组患者治疗前后脑动脉血流的平均流速(Vm)和脉动指数(PI),CT影像比较2组患者手术前后颞肌厚度,记录2组患者术后并发症发生率。结果 2组患者术后7 d、3个月m RS评分均明显低于术前1 d(P<0.05);与对照组相比,研究组3个时间点的mRS评分均明显降低(P<0.05)。2组患者术后7 d、3个月PI评分均明显低于术前1 d(P<0.05);与对照组相比,研究组3个时间点的PI评分均明显降低(P<0.05)。2组患者术后7 d、3个月Vm均明显高于术后1 d(P<0.05);与对照组相比,研究组3个时间点的Vm均显著升高(P<0.05)。对照组术后颞肌萎缩及咀嚼无力发生率明显高于研究组(30.0%比5.3%,45.0%比15.8%),颞肌厚度明显小于研究组(4.16±0.14比5.04±0.22),差异均有统计学意义(P<0.05)。结论 颞浅动脉-大脑中动脉搭桥术治疗缺血性烟雾病相比颞肌贴覆术,能够有效促进脑血流的恢复,改善缺血性烟雾病的脑血流状况,缓解缺血症状。而颞肌贴覆术,由于没有影响颞浅动脉对于颞肌的血运,因此术后出现颞肌萎缩相关并发症的概率明显减低,临床上需要重视开颅过程中对颞浅动脉的保护,必要时予以重建。Objective To compare the effect of superficial temporal artery-middle cerebral artery bypass grafting and temporalis muscle taping on neurological function and cerebral blood flow in adult patients with ischemic moyamoya disease(MMD),and temporalis muscle blood supply and postoperative complications.Methods Thirty-nine MMD patients admitted to the First Hospital of Qinhuangdao September 2020 to December 2022 were selected as the research subjects.Among them,20 patients underwent temporalis muscle taping surgery alone as the control group,and 19 patients underwent superficial temporal artery-middle cerebral artery bypass surgery as the research group.The modified Rankin scale(m RS)was used to compare the neurological recovery of the two groups before and after treatment.Transcranial Doppler was used to detect the mean velocity(Vm)and pulsatility index(PI)of the cerebral artery blood flow in the two groups before and after treatment,as well as CT images.The temporalis muscle thickness of the patients in the two groups before and after surgery was compared,and the incidence of postoperative complications in the two groups was recorded.Results The m RS scores of both groups 7 days and 3 months after surgery were significantly lower than 1 day before surgery(P<0.05),and compared with the control group,the m RS scores of the study group at three-time points were significantly lower(P<0.05).The PI scores of the two groups 7 days and 3 months after surgery were significantly lower than 1 day before surgery(P<0.05),and compared with the control group,PI scores at all time points were significantly reduced(P<0.05).The Vm of the two groups 7 days and 3 months after surgery were significantly higher than that 1 day after surgery(P<0.05).Compared with the control group,VM of the study group at three-time points were significantly higher than that 1 day after surgery(P<0.05).The incidence of postoperative temporalis muscle atrophy and chewing weakness in the control group(30%vs 45%)was significantly greater than that in the st

关 键 词：颞浅动脉 颞肌萎缩 颞浅动脉吻合 翼点入路 

分 类 号：R743.4[医药卫生—神经病学与精神病学]