痉挛性斜颈的手术治疗(附580例报道)
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摘要
目的探讨痉挛性斜颈(ST)的手术方法及其疗效。方法回顾性分析1995~2015手术治疗的580例痉挛性斜颈的临床资料。借助肌电图、CT或MRI等检查判断参与痉挛的肌群,将痉挛肌肉分为原动肌、协同肌、随动肌,对原动肌做去神经术和肌切断术,协同肌做去神经术,随从肌可不予处理,从而形成三种术式:术式一,面部旋向侧颈后痉挛肌肉选择性切除术;术式二,同侧颈神经1~6后支选择性切断术;术式三,副神经切断术。旋转型ST和侧屈型ST采用二联术或三联术,后仰型ST采用双侧术式一和术式二组合,前屈型ST采用双侧术式三组合,混合型ST分期采用颈部神经选择性切断术和肌肉选择性切除术。结果565例术后随访6个月~15年;术后6个月评估疗效:痊愈429例,显效68例,进步52例,无效16例;优良率为88%。无死亡、无严重并发症。结论选择性周围神经切断术及肌切断术是治疗痉挛性斜颈安全有效的方法。
ObjectiveTo investigate the curative effects of selective peripheral neurotomy and muscle amputation on thespasmodic torticollis(ST).MethodsThe muscles involved in the spasm were revealed by electromyography(EMG) and CT,or MRIexaminations in 580 patients with ST.The muscles related to the spasm were divided into the prime mover which was cut off,synergisticmuscles which were denerved and slave muscles which were not treated.The three kinds of surgical methods which were formed were asfollows:(1) selective posterior cervical spam muscle resection;(2) selective posterior rhizotomy of cervical nerve 1~6(C1~6);(3)neurotomy of accessory nerve.The combination of the three methods is called "Triple treatment".The patients with rotatory ST andlateral flexion ST were treated by the triad or bigeminal methods.The patients with retrocollic spasm were bilaterally treated by the firstand the second methods.The patients with mixed type ST were treated by selective cervical neurotomy and selective muscle resection.ResultsThe following up for 6~12 months showed that of 565 followed up,429 were cured,68 received good outcomes,52 were on themend and 16 had unchanged symptoms.The total excellent and good rate was 88.0%.No patients died and the serious complications didnot occur in all the patients.ConclusionThe selective peripheral neurotomy and muscle amputation are the safe and effective methodsto treat ST.
ObjectiveTo investigate the curative effects of selective peripheral neurotomy and muscle amputation on thespasmodic torticollis(ST).MethodsThe muscles involved in the spasm were revealed by electromyography(EMG) and CT,or MRIexaminations in 580 patients with ST.The muscles related to the spasm were divided into the prime mover which was cut off,synergisticmuscles which were denerved and slave muscles which were not treated.The three kinds of surgical methods which were formed were asfollows:(1) selective posterior cervical spam muscle resection;(2) selective posterior rhizotomy of cervical nerve 1~6(C1~6);(3)neurotomy of accessory nerve.The combination of the three methods is called "Triple treatment".The patients with rotatory ST andlateral flexion ST were treated by the triad or bigeminal methods.The patients with retrocollic spasm were bilaterally treated by the firstand the second methods.The patients with mixed type ST were treated by selective cervical neurotomy and selective muscle resection.ResultsThe following up for 6~12 months showed that of 565 followed up,429 were cured,68 received good outcomes,52 were on themend and 16 had unchanged symptoms.The total excellent and good rate was 88.0%.No patients died and the serious complications didnot occur in all the patients.ConclusionThe selective peripheral neurotomy and muscle amputation are the safe and effective methodsto treat ST.
引文
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[7]华春晖,刘春,薛泳华,等.副神经微血管减压术治疗痉挛性斜颈效果及安全性分析[J].山东医药,2016,56(38):95-96.
[8]陆天宇,徐武,戴宇翔,等.硬膜下超选择神经根切断术治疗痉挛性斜颈(附22例临床分析)[J].立体定向和功能性神经外科杂志,2015,28(01):5-8.
[9]毛剑男,梁维邦.痉挛性斜颈的治疗进展[J].江苏医药,2014,40(14):1700-1702.
[10]Chen XK.Selective resection and deneration of cervical muscles in the treatment of spasmodic torticollis:results in60 cases[J].Neurosurgery,1981,8:680-688.
[11]Chen XK,Ji SX.Operative treatment of bilateral retrocollis[J].Acta Neurochir(Wien),1991,113:180-185.
[12]Chen XK,Ma AB,Lian J,et al.Selective denervation and resection of cervical mnscles in the treatment of spasmodictorticollis,long term follow up results in 207 cases[J].Stereotactic Funct Neurosurg,2000,75:96-102.
[13]钱海,周忠清,石祥恩.痉挛性斜颈2种手术方法效果比较[J].郑州大学学报(医学版),2012,47(1):133-134.
[2]朱正凯,林少华,李亮明.旋转型痉挛性斜颈的个体化手术治疗[J].海南医学,2017,28(10):1693-1694.
[3]姬绍先,马安保,梁健,等.痉挛性斜颈的应用解剖和外科治疗(附648例报告)[J].中国临床神经外科杂志,2009,14(2):65-68.
[4]姬绍先,马安保,梁健,等.微侵袭手术治疗侧屈型痉挛性斜颈81例[J].中国临床神经外科杂志,2010,15(7):393-395.
[5]Muller U.The monogenic primary dystonias[J].Brain,2009,32(Pt 8):2005-2025.
[6]孟佑强,薛泳华,浦奔放,等.副神经切断联合远端毁损术治疗痉挛性斜颈的临床疗效分析[J].现代生物医学进展,2016,16(15):3673-3675.
[7]华春晖,刘春,薛泳华,等.副神经微血管减压术治疗痉挛性斜颈效果及安全性分析[J].山东医药,2016,56(38):95-96.
[8]陆天宇,徐武,戴宇翔,等.硬膜下超选择神经根切断术治疗痉挛性斜颈(附22例临床分析)[J].立体定向和功能性神经外科杂志,2015,28(01):5-8.
[9]毛剑男,梁维邦.痉挛性斜颈的治疗进展[J].江苏医药,2014,40(14):1700-1702.
[10]Chen XK.Selective resection and deneration of cervical muscles in the treatment of spasmodic torticollis:results in60 cases[J].Neurosurgery,1981,8:680-688.
[11]Chen XK,Ji SX.Operative treatment of bilateral retrocollis[J].Acta Neurochir(Wien),1991,113:180-185.
[12]Chen XK,Ma AB,Lian J,et al.Selective denervation and resection of cervical mnscles in the treatment of spasmodictorticollis,long term follow up results in 207 cases[J].Stereotactic Funct Neurosurg,2000,75:96-102.
[13]钱海,周忠清,石祥恩.痉挛性斜颈2种手术方法效果比较[J].郑州大学学报(医学版),2012,47(1):133-134.