保全和重建听骨链的高位和全程面神经减压术  

A surgical approach to higher level and total course decompression of facial nerve with hearing bone chain reservation and reconstruction

作　　者：胡宝华[1] 杨金维[1] 张道行[2] 杨和钧[2] 

机构地区：[1]浙江省余姚市人民医院耳鼻咽喉科,315400 [2]首都医科大学附属北京友谊医院耳鼻咽喉科

出　　处：《中国中西医结合耳鼻咽喉科杂志》2003年第4期167-169,共3页Chinese Journal of Otorhinolaryngology in Integrative Medicine

摘　　要：目的 探讨颞骨外伤性骨折面瘫,保全和重建听骨链的面神经全程减压术对面瘫与听力恢复的效果。方法 对11例颞骨骨折引起面瘫者,行保全和重建听骨链的面神经全程减压手术(颞下窝迷路外径路6例,乳突径路4例,乳突颅中窝联合径路1例)。结果 术后随访0.5～4.2年,面瘫恢复至H-BⅠ级8例,H-BⅡ级2例,H-B Ⅳ级1例。听力恢复:术前有听力下降的10例中,气、骨导差缩小到10dB 6例,气、骨导差缩小到20dB 3例,1例重度感音性耳聋听力无改善。结论 颞骨外伤性骨折面瘫,行面隐窝与颞下窝迷路外径路,进行全段面神经减压保全和重建听骨链效果满意。Objective To explore a better surgical approach to higher level and total course decompression of facial nerve with hearing bone chain reservation and reconstruction and to evaluate its therapeutic effect on the recovery of facial palsy and hearing loss. Methods 11 cases with facial palsy, caused by temporal bone fracture, were treated by surgical therapy of total course decompression of facial nerve with hearing bone chain retained and reconstructed. Among them, 6 cases were operated on via extra-labyrinthine sub-temporal approach, 4 cases viatrans-mastoid approach and 1 case via a combining approach with trans-mastoid and middle cranial fossa. Results After a period of following-up from 0. 5-4. 2 years, the recovery of facial palsy was H-B Ⅰ level among 8 cases,Ⅱ level among 2 cases, and Ⅳ level for one case. Furthermore, a-mong the 10 cases with hearing loss before operation, 6 cases showed reduced AC-BC gap to 10 dB, 3 cases reduced to 20 dB, and 1 case, with severe sensorineural hearing loss, showed no significant improvement in hearing level. Conclusion A surgical therapy to carry out total course decompression of facial nerve with hearing bone chain reservation and reconstruction is significantly effective on cases with facial palsy caused by temporal bone fracture via an approach of facial recess and sub-temporal extra-labyrinthine.

关 键 词：听骨链保全 听骨链重建 颞骨外伤性骨折 面瘫 面神经全程减压术 听力恢复 

分 类 号：R764[医药卫生—耳鼻咽喉科]