摘要
目的 探索吻合血管的去神经拇、趾短伸肌游离移植修复晚期面瘫的疗效。方法2003年4月～2005年4月，采用显微外科技术以去神经拇、趾短伸肌游离移植修复晚期面瘫26例，其中男10例，女16例。年龄16～65岁。病程6个月～60年。将肌肉的肌腱端悬吊于患侧鼻翼、鼻唇沟中点、口角及颏窝，肌腹埋藏于咬肌的支配神经周围，并进行跗外侧动、静脉与颞浅动、静脉或面动、静脉吻合，修复面瘫的口鼻畸形及运动障碍。术后采用Douglasl临床指标及Stennert评分标准进行疗效评价。结果术后26例患者的静态外观均即刻恢复双侧对称；均获随访6个月～2年。6个月后有明显的动态外观恢复：病史在2年以上者23例，除1例仅有轻微口角动度恢复外，余22例术后均可自然微笑并基本对称地暴露牙齿。病史在2年以下者3例，仅1例可自然微笑并基本对称地暴露牙齿，1例可微笑但不能对称暴露牙齿，另1例仅有口角动作但不能有协调的表情。经Douglas指标评价，效果为“卅”者共23例。经Stennert评分术前术后差值在5分以上者22例。结论吻合血管的去神经拇、趾短伸肌游离移植修复晚期面瘫，术式简便、创伤小、疗程短、效果可靠。
Objective To investigate the result of free vascular transplantation of denervated extensor digitorum brevis and extensor hallusis brevis for the treatment of late facial paralysis. Methods From April 2003 to April 2005, 26 cases of facial paralyces were treated by transplantation of denervated extensor digitorum brevis and extensor hallusis brevis. During operation, the ends of the tendons were fixed at ala nasi, middle point of nasal labial fold,oral commisure and chin; the muscle belly were put around the masseter nerve to correct the nasal and oral deformity, microsurgery was applied to anastomose the tarsus lateral vessels to the superficial temporalis vessels or the facial vessels. The result of the operation was evaluated by the Standard of Douglas Harrison and the Paresis Assessment scoring system of Stennert. Results The static appearance was satisfactory in 26 cases after operation, the bilateral oral commisure was symmetry and the dynamic appearance was greatly improved 6 months after operation. Among the 23 cases whose disease history was above 2 years, all could smile naturally and show their teeth symmetrically except 1 case who could only move the oral commissure. Among the 3 cases whose disease history was less than 2 years, one could smile naturally and show his teeth symmetrically, one could smile but could not show his teeth symmetrically, another could move oral commissure but have no motion appearance. The result was evaluated as＂卅＂ according to Standard of Douglas Harrison, accounting for 88% （23/26）. Evaluated according to the Paresis Assessment scoring system of Stenert, the difference before operation and after operation was more than 5, accounting for 86% （22/26）. Conclusion The free vascular transplantation of denervated extensor digitorum brevis and extensor halluces brevis can reconstruct the oral appearance for the treatment of late facial paralysis.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2006年第5期522-525,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
面瘫
趾短伸肌
拇短伸肌
去神经
Facial paralysis Extensor digitorum brevis Extensor halluces brevis Denervated
