【作者】 何曦；

【导师】 王海波；

【作者基本信息】 山东大学 ， 临床医学（专业学位）， 2013， 硕士

【摘要】 目的：本文通过回顾颞骨骨折性面瘫相关研究并分析我院临床资料,探讨颞骨骨折性面瘫手术治疗的适应证、手术时机、手术方式以及影响预后的因素等,以指导临床诊疗工作。方法：收集2010年7月至2012年7月间因颞骨骨折性面瘫在山东省立医院集团眼耳鼻喉医院行手术治疗的病例38例,回顾性分析辅助检查、骨折分类及手术入路等因素与手术预后的关系,以House-Brackmann分级法作为疗效标准,统计学方法采用卡方检验,分析软件为SPSS。结果：4男性30例,女性8例；年龄范围3-53岁,平均34.6岁。外伤原因主要有车祸伤17例(44.7%),摔伤8例(21.1%),头部撞击伤11例(28.9%),头部挤压伤2例(5.3%)。左侧面瘫者16例(42.1%),右侧21例(55.3%)双侧1例(2.6%)。达到H-B分级Ⅱ级以上21例(55.3%),Ⅲ级以上36例(94.7%)。病程达3周以后,神经电图显示结果与术后预后不符合,变性较少组反而预后差,3周以上者30例,神经变性大于90%者8例,75%术后恢复至Ⅱ级以上,变性小于90%有22例,术后Ⅱ级以上仅40.9%。鞘膜完整者18例,13例(72.2%)术后恢复至Ⅱ级以上,鞘膜可见糜烂、缺损的有20例,8例(40%)术后面神经功能恢复至Ⅱ级以上。两组间差异有统计学意义(P<0.05)。纵行骨折21例(55.3%),横行骨折9例(23.7%),混合型骨折7例(18.4%)术后面神经功能恢复至Ⅱ级以上分别为12例(57.1%)、5例(66.7%)、4例(57.1%),不同骨折类型组间无明显统计学差异(P>0.05)。病程3个月内手术病例21/32(65.6%)术后恢复至Ⅱ级以上,3个月以上手术6例,均未恢复至Ⅱ级,差异有统计学意义(P<0.05)。35例患者行颅中窝径路面神经减压,30例(78.9%)术中可见膝状神经节水肿明显或有骨片刺入、压迫,术后其中18例(52.9%)面神经功能恢复至Ⅱ级以上,32例(94.1%)术后面神经功能达III级以上。结论：本研究提示,面神经减压术对治疗颞骨骨折性面瘫有肯定的疗效,应结合患者颞骨骨折的类型和部位选择正确的手术方式。多数颞骨骨折患者面神经损伤位于膝状神经节,颅中窝径路可更好的暴露膝状神经节,对面神经有效减压。膝状神经节区神经减压范围包括膝状神经节,迷路段和部分水平段,减压至神经没有水肿的正常处即可,也可以获得很好的神经恢复结果,不需要全程面神经减压。面神经减压术应尽早实施,面瘫发生3个月以内手术效果更佳。更多还原

【Abstract】 Objective:There are dispute in surgical intervention for facial paralysis caused by temporal fracture. In this article, we review related researches and analysis the clinic data we collected, to discuss the indication of facial nerve surgery, the best time and approach of operation, as well as prognostic factors.Methods:A retrospective analysis of38patients with facial nerve paralysis resulting from temporal bone fracture, who underwent decompression surgery or facial nerve transplantation. Evaluation of facial nerve function by House-Brackmann nerve grade system, chi-square test is used to analyze the data.Results:Normal or subnormal facial nerve function (HB1or HB2) is considered to be good functional result.21in38(55.3%) patients got good result,36(94.7%) received Ⅰ～Ⅱ grade recovery. In cases of long-standing (>3weeks) facial paralysis,6in8of degeneration beyond90%recovered to H-B grade Ⅱ, while9in22who degenerate less than90%recovered to grade Ⅱ, EMG test and CT are more helpful for prognosis in cases of long-standing facial paralysis. Patients13in18(72.2%) whose nerve sheath is intact received good recovery, while defective ones8in20(40%) received good results. There were12/21longitudinal fractures,5/9transverse fractures and4/7mixed factures, who at last had Ⅰ～Ⅱ grade recovery, there is no significant statistical difference in different fracture types. Moreover, comparing facial nerve decompression within3months of injury to beyond3months of injury, recovery to H-B Ⅰ～Ⅱ nerve function was59.5%and0%, the statistical difference is significant (P<0.05). We chose middle cranial fossa approach facial decompression for34 patients depending on the results of CT and Schirmer Tear Test,30of them were found lesions at Geniculate Ganglion, and18of them recovered to H-B Ⅰ～Ⅱ,14recovered to Ⅲ.Conclusion:Facial decompression is effective in treating facial paralysis caused by temporal fracture. Most lesions happen in the area of GG, while middle cranial fossa approach can give best exposure of these areas, for most patients, we chose this approach for the surgery. While lesions set in GG, local decompression is carried out, and most traumatic facial paralysis patients recovered to H-B Ⅱ, there is no need for total decompression. Surgery carried out beyond3months did not receive good recovery, so the operation should be performed in3months.更多还原