中国现代神经疾病杂志 ›› 2025, Vol. 25 ›› Issue (4): 317-322. doi: 10.3969/j.issn.1672-6731.2025.04.009

• 临床研究 • 上一篇    下一篇

2 异常肌反应与Z-L反应联合监测在面肌痉挛锁孔入路微血管减压术中的应用

余聚, 关炎, 许亮*()   

  1. 215004 苏州大学附属第二医院神经外科
  • 收稿日期:2025-01-02 出版日期:2025-04-25 发布日期:2025-05-19
  • 通讯作者: 许亮
  • 基金资助:
    江苏省医学重点学科建设单位(JSDW202225); 苏州大学附属第二医院学科建设托举工程项目(XKTJ-XK202402)

Application of abnormal muscle response and Z-L response combined monitoring during keyhole microvascular decompression of hemifacial spasm

Ju YU, Yan GUAN, Liang XU*()   

  1. Department of Neurosurgery, The Second Affiliated Hospital of Soochow University, Suzhou 215004, Jiangsu, China
  • Received:2025-01-02 Online:2025-04-25 Published:2025-05-19
  • Contact: Liang XU
  • Supported by:
    Jiangsu Provincial Medical Key Discipline Cultivation Unit(JSDW202225); Subject Construction Lifting Project of The Second Affiliated Hospital of Soochow University(XKTJ-XK202402)

摘要:

目的: 对比分析异常肌反应监测联合Z-L反应监测与单纯异常肌反应监测在面肌痉挛锁孔入路微血管减压术中的应用价值。方法: 纳入2014年1月至2024年4月在苏州大学附属第二医院行乳突后锁孔入路微血管减压术的258例原发性面肌痉挛患者,分别行异常肌反应监测(AMR组,102例)和异常肌反应监测联合Z-L反应监测(AMR+ZLR组,156例),计算手术有效率,记录术后并发症。结果: AMR+ZLR组术后7 d 145例痊愈、11例无效,手术有效率为92.95%(145/156);术后6个月151例痊愈、5例无效,手术有效率为96.79%(151/156)。AMR组术后7 d 86例痊愈、16例无效,手术有效率为84.31%(86/102);术后6个月92例痊愈、10例无效(其中2例为复发),手术有效率为90.20%(92/102)。AMR+ZLR组术后7 d(χ2=4.908,P=0.027)和6个月(χ2=4.904,P=0.027)手术疗效均优于AMR组。术后1 d,AMR+ZLR组有12例出现轻微面瘫,于术后7 d内恢复;AMR组有1例出现耳鸣、1例出现头晕,均于术后3 d内恢复,18例出现轻微面瘫,于术后7 d内恢复。结论: 微血管减压术是治疗面肌痉挛的有效手段,手术有效率较高,术中异常肌反应监测联合Z-L反应监测较单纯异常肌反应监测可以提供更有价值的电生理指导。

关键词: 痉挛, 面部肌肉, 微血管减压术, 神经电生理监测, 监测,手术中

Abstract:

Objective: To compare the monitoring effect of abnormal muscle response (AMR) combined Z-L response (ZLR) and simple AMR in keyhole microvascular decompression (MVD) for hemifacial spasm (HFS). Methods: Total 258 patients with primary HFS treated with keyhole MVD between January 2014 and April 2024 from The Second Affiliated Hospital of Soochow University were analyzed retrospectively, including 102 patients underwent simple AMR (ARM group) and 156 patients underwent intraoperative monitoring of AMR combined ZLR (AMR + ZLR group). Calculate the surgical efficiency, and record the occurrence of postoperative complications. Results: In the AMR + ZLR group, 145 cases recovered 7 d after surgery, 11 cases were ineffective, and the surgery effective rate was 92.95% (145/156); 151 cases recovered 6 months after surgery, 5 cases was ineffective, and the surgery effective rate was 96.79% (151/156). In the AMR group, 86 cases recovered at 7 d after surgery, 16 cases were ineffective, and the surgery effective rate was 84.31% (86/102); 92 cases recovered 6 months after surgery, 10 cases were ineffective (2 cases relapsed), and the surgery effective rate was 90.20% (92/102). The MVD effective rates in AMR + ZLR group were better than that in AMR group at 7 d and 6 months after surgery (χ2 = 4.908, P = 0.027; χ2 = 4.904, P = 0.027). On the first day after surgery, 12 cases in the AMR + ZLR group experienced mild facial paralysis, which recovered within 7 d after surgery. In the AMR group, one case had tinnitus and one case had dizziness, both of which recovered within 3 d after surgery, 18 cases experienced mild facial paralysis, which recovered within 7 d after surgery. Conclusions: Intraoperative monitoring of AMR combined ZLR provides more valuable neurosurgical guidance than simple AMR during MVD for HFS. MVD is an effective method for the treatment of HFS, and the MVD rate of keyhole in our center has maintained a high level.

Key words: Spasm, Facial muscles, Microvascular decompression surgery, Neurophysiological monitoring, Monitoring, intraoperative