【摘要】 目的探讨内镜辅助下选择性颈神经根切断术治疗痉挛性斜颈的疗效。方法回顾性分析2008年1月至2009年6月显微手术治疗的57例痉挛性斜颈患者的临床资料。该显微手术,术中不咬除枕骨鳞部及枕大孔,在内镜辅助下行硬膜下双侧副神经根及颈1脊神经根切断。结果全部患者平均随访7个月。100%病人术后立即感痉挛状态明显缓解;随访期间缓解率为94.7%(54/57),痉挛状态不同程度复发3例(5.3%)。8例(14.0%)发生不同程度吞咽困难,随访期间恢复正常5例,明显好转2例,无明显变化而影响生活质量1例(该例仅随访1个月);颅内感染2例(3.5%),皮下积液伴长期发热1例(1.8%),均治愈出院;长期颈肩痛3例(5.3%)。结论在治疗痉挛性斜颈的该术式中不咬除枕骨鳞部及枕大孔,在神经内镜辅助下行硬膜下双侧副神经根及颈1神经根切断,在不降低疗效的前提下,可进一步减少手术创伤及手术并发症的发生。更多还原

【Abstract】 Objective To explore the curative effect of selective peripheral denervation on spasmodic torticollis. Methods The clinical data of 57 patients with spasmodic torticollis,who were treated by selective peripheral denervation from January,2008 to June,2009,were analyzed retrospectively. The selective peripheral denervation was completed by modified Foerster-Dandy operation,in which the bilateral accessory roots and first cervical nerve roots were subdurally cut off under an endoscope without destruction of the occipital squama and foramen magnum. All the patients were following up for 1 to 18 months. Results The spasticity was relieved immediately after the operation in all the patients. The relief rate of the spasticity was 94.7%(54/57) during the following-up period. The spasticity recurred in 3 patients during the following up period. The postoperative complications included dysphagia in different degree in 8 patients(in whom,dysphagia disappeared in 5 cases,dysphagia was significantly relieved in 2,and unchanged in 1 during the following up period) ,intracranial infection in 2 patients,subcutaneous effusion and fever in 1 patient(who was cued when being discharged from hospital) ,and long-term neck and shoulder pain in 3 patients. Conclusions That cutting-off the subdural bilateral accessory roots and first cervical nerve roots is achieved without destruction of the occipital squama and foramen magnum reduces the surgery-side injury and surgical complications,and can ensure the curative effect.更多还原