面神经松解术治疗Bell麻痹后痉挛性面瘫后遗症的疗效观察  

Observation on the efficacy of facial nerve neurolysis in the treatment of spastic facial paralysis sequelae after Bell′s palsy

作　　者：蔡小敏 赵华[1] 唐寅达[1] 王好鹏 沈艺漫 王柏淼 应婷婷[1] 朱晋[1] 李世亭[1] Cai Xiaomin;Zhao Hua;Tang Yinda;Wang Haopeng;Shen Yiman;Wang Baimiao;Ying Tingting;Zhu Jin;Li Shiting(Department of Neurosurgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院神经外科,上海200092

出　　处：《中华神经外科杂志》2024年第10期1033-1037,共5页Chinese Journal of Neurosurgery

基　　金：上海市科技计划项目(21Y21900500);上海申康医院发展中心市级医院诊疗技术推广及优化管理项目(SHDC120201144)。

摘　　要：目的探讨面神经松解术治疗Bell麻痹后痉挛性面瘫后遗症的效果及可能影响其治疗效果的因素。方法回顾性分析2020年7月至2022年1月上海交通大学医学院附属新华医院神经外科32例接受面神经松解术治疗Bell麻痹后痉挛性面瘫后遗症患者的临床资料,其中术前House-Brackmann分级(简称H-B分级)Ⅱ级26例,Ⅲ级6例,病程>1年者8例,≤1年者24例。术后1年采用HB分级评估患者术后面瘫程度是否恶化,以评价手术的安全性;采用痉挛性面瘫后遗症总体缓解度自我评分方法评估总体缓解程度,并将评分<5分视为无缓解(无缓解组),≥5分视为有效缓解(有效缓解组),分析可能影响总体缓解程度的因素;采用痉挛性面瘫后遗症症状缓解度自我评分方法评估面部紧束感、面部僵硬感、联带运动、面肌抽动、睁眼困难及眼裂变小六大症状的缓解程度并计算有效缓解率。结果32例患者的手术均顺利完成。出院时HB分级Ⅱ级23例(71.9%),Ⅲ级9例(28.1%)。6例(18.8%)患者术后出现耳后区域及耳廓皮肤麻木,5例(15.6%)患者出现耳后皮肤隐痛。术后1年32例患者均获得临床随访,H-B分级Ⅱ级28例(87.5%),Ⅲ级4例(12.5%);术后存在耳部皮肤麻木或隐痛患者的症状均消失;26例(81.3%)患者的痉挛性面瘫后遗症总体得到有效缓解,6例(18.7%)无缓解,有效缓解组与无缓解组患者的性别、年龄、手术侧别、术前面瘫程度的差异均无统计学意义(均P>0.05),而病程的差异具有统计学意义(P=0.023);痉挛性面瘫后遗症六大症状的有效缓解率按上述顺序依次为93.8%(30/32)、90.6%(29/32)、81.3%(26/32)、75.0%(24/32)、50.0%(16/32)、46.9%(15/32)。结论面神经松解术可有效缓解痉挛性面瘫后遗症症状,而早期手术可能是提高手术疗效的关键。ObjectiveTo investigate the therapeutic efficacy of facial nerve neurolysis in treating spastic facial paralysis sequelae after Bell′s palsy,and to identify factors that may influence treatment outcomes.MethodsA retrospective analysis was conducted on the clinical data of 32 patients with spastic facial paralysis sequelae following Bell′s palsy,who underwent facial nerve neurolysis at the Department of Neurosurgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from July 2020 to January 2022.Preoperative House-Brackmann(H-B)grading showed 26 cases with gradeⅡand 6 cases with gradeⅢ.There were 8 patients having a disease course>1 year and 24 patients with the disease course≤1 year.The safety of the surgery was assessed by evaluating whether the severity of facial paralysis worsened one year postoperatively using the HB grading system.The overall alleviation of spastic facial paralysis sequelae was evaluated using a self-assessment scale,with a score of<5 indicating no alleviation(non-alleviation group)and a score of≥5 indicating effective alleviation(effective alleviation group).Factors potentially influencing the overall alleviation were analyzed.The effectiveness of symptom alleviation for six major symptoms,including facial tightness,facial stiffness,synkinesis,facial muscle twitching,difficulty in opening eyes,and smaller eye fissures was assessed using a self-assessment scale respectively,and the effective alleviation rates were also calculated.ResultsAll 32 surgeries were successfully completed.Upon discharge,23 patients(71.9%)were classified as HB gradeⅡand 9 patients(28.1%)as HB gradeⅢ.Postoperative complications included numbness in the skin of the postauricular region and auricle in 6 patients(18.8%)and mild pain in the postauricular skin in 5 patients(15.6%).One year postoperatively,all 32 patients were followed up clinically;28 patients(87.5%)were classified as H-B gradeⅡand 4 patients(12.5%)as HB gradeⅢ;symptoms of numbness or mild pain in the ear re

关 键 词：Bell麻痹 治疗结果 神经松解术 痉挛性面瘫后遗症 

分 类 号：R651.3[医药卫生—外科学]