多支肌肉异常肌反应监测在面肌痉挛微血管减压术中的应用

doi:10.3969/j.issn.1672-6731.2020.11.010

摘要/Abstract

摘要：

研究背景 异常肌反应作为评价减压程度和效果的指标广泛应用于面肌痉挛微血管减压术中电生理监测，由于个体差异、记录肌肉单一等原因，导致术中异常肌反应阳性率差异较大。为了观察与评价该项指标的临床应用价值，本研究选择患侧面神经颧支作为刺激点，同时记录同侧面神经多分支支配肌肉的异常肌反应，以提高术中异常肌反应阳性率。方法纳入2017年1月至2019年6月确诊的96例面肌痉挛并行微血管减压术患者，于术中刺激患侧面神经颧支，同时记录同侧额肌、眼轮匝肌、口轮匝肌和颏肌的异常肌反应。结果额肌、眼轮匝肌、口轮匝肌和颏肌的异常肌反应总阳性率为97.92%（94/96），其中额肌异常肌反应阳性率为43.75%（42/96）、眼轮匝肌为38.54%（37/96）、口轮匝肌为64.58%（62/96）、颏肌为78.13%（75/96），颏肌和口轮匝肌异常肌反应阳性率均高于额肌（P=0.000，0.006）和眼轮匝肌（P=0.000，0.000）。术后异常肌反应消失患者治愈率高于异常肌反应仍持续存在患者[94.38%（84/89）对3/5；Fisher确切概率法：P=0.043]。结论同时监测面神经多分支支配肌肉可明显提高异常肌反应阳性率，术后异常肌反应消失可辅助评估微血管减压术疗效，判断预后。

关键词: 痉挛, 面部肌肉, 微血管减压术, 面神经, 肌电描记术

Abstract:

Objective Abnormal muscle response (AMR) is widely used as an indicator of the degree and effect of surgery during microvascular decompression (MVD) for hemifacial spasm (HFS). However, the positive rate of AMR during operation is quite different because of individual differences and single recording of muscle, which can not predict surgical outcomes. We present an improved method to record from multiple muscles innervated by multiple branches of the facial nerve to enlarge the AMR positive rate. Methods A total of 96 HFS patients in our hospital from January 2017 to June 2019, underwent MVD with intraoperative AMR monitoring. Ipsilateral frontalis, orbicularis oculi, orbicularis oris and mentalis were simultaneously monitored for AMR in stimulating the affected zygomatic branch of facial nerve in all cases. The effect of MVD for facial nerve was analyzed based on the disappearance of intraoperative AMR and the postoperative result. Results The AMR positive rate of frontalis was 43.75% (42/96), of orbicularis oculi was 38.54% (37/96), of orbicularis oris was 64.58% (62/96) and of mentalis was 78.13% (75/96). Total AMR positive rate was further improved to 97.92% (94/96) when the 4 muscles were monitored simultaneously. The AMR positive rates between multiple muscles monitoring group and any single muscle monitoring groups were significantly different (P=0.000, for all). The AMR positive rates of orbicularis oris and mentalis were higher than that of frontalis (P=0.000, 0.006) and orbicularis oculi (P=0.000, 0.000). The postoperative results were statistically different between AMR complete disappearance group and AMR persistence group (Fisher exact probability:P=0.043). Conclusions The method of multibranch facial muscles monitoring can effectively increase the AMR positive rate. AMR disappearance after the operation can evaluate the effect of facial nerve decompression and judge the prognosis.

Key words: Spasm, Facial muscles, Microvascular decompression surgery, Facial nerve, Electromyography

宫达森, 崔云, 岳树源. 多支肌肉异常肌反应监测在面肌痉挛微血管减压术中的应用[J]. 中国现代神经疾病杂志, 2020, 20(11): 987-992.

GONG Da-sen, CUI Yun, YUE Shu-yuan. Application of multibranch abnormal muscle response monitoring during microvascular decompression for hemifacial spasm[J]. Chinese Journal of Contemporary Neurology and Neurosurgery, 2020, 20(11): 987-992.

http://journal11.magtechjournal.com/cjcnn/CN/Y2020/V20/I11/987

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Application of multibranch abnormal muscle response monitoring during microvascular decompression for hemifacial spasm

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Application of multibranch abnormal muscle response monitoring during microvascular decompression for hemifacial spasm

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