面神经液压与面神经电图的相关性研究

目的 探讨面神经电图作为面神经减压手术指征的病理生理学基础。方法 利用电生理仪和伺服微变量微压系统，对正常和压榨伤后面瘫不同时期的豚鼠，作面神经电图检查，再采用微创测压法进行面神经液压的测量，得出面神经损伤后不同时期的面神经动作电位降幅及相应的面神经液压，并观察不同时期面神经光镜和电镜下的组织学改变。结果 面神经损伤3d至3周，随着面神经液压的升高，面神经动作电位降幅百分数亦增加，二者间有明显相关性，损伤后2周和3周，面神经液压和面神经动作电位降幅的相关系数分别为0．88和0．51。神经液压的变化与面神经Wallerian变性各期组织学改变相一致。结论 在面瘫3周内，面神经电图的改变可间接反映面神经液压的变化，并可为面神经减压术的时机提供客观、可靠的实验依据。     

丝素导管修复面神经缺损的实验研究

目的探讨多孔丝素材料用于面神经缺损修复的可能。方法以多孔丝素导管修复SD大鼠面神经5 mm缺损,设壳聚糖导管为对照。术后4、6、8周行电生理学检查,2、4、6、8周取材HE及甲苯胺蓝染色组织学检查,以了解神经再生及功能恢复情况。结果随时间推移,大鼠神经得以成功再生,8周时多孔丝素导管组的再生神经动作电位平均振幅已达健侧的24．9％±5．7％(x±s,以下同),与壳聚糖导管组(13．7％±3．4％)比较差异无统计学意义(P=1．125);8周时丝素导管组有髓神经纤维平均计数(62．5±6．3)与壳聚糖导管组(55．3±8．4)比较差异有统计学意义(P= 0．016)。结论多孔丝素导管对面神经缺损能起到一定作用,有可能促进和引导神经再生。     

豚鼠面神经逆行诱发电位的实验研究

对豚鼠面神经逆行诱发电位进行了系列观察。结果显示：电刺激颧支，在及鼠膝状神经节记录的ＡＥＰ为一单相的短潜伏期电位；面神经管壁，鼓膜后上方、头皮记录的ＡＥＰ为双相短潜伏期电位。提示ＡＥＰ对神经受损高度敏感，且在受损后立即出现改变，故能早期检测及监测神经病变，亦是功能恢复的可靠判断指标。     

神经营养因子与面神经的损伤及再生研究进展

神经营养因子（ＮＴＦ）是一类能对中枢和周围神经发挥营养作用的濉太类物质和蛋白质。随着科学的发展,ＮＴＦ在面神经损伤及再生中的作用越来越受到关。本语文对ＮＴＦ的研究概况,面神经损伤后其运动神经元和周围神经ＮＴＦ受体和内源性ＮＴＦ的改变及外源性怕作用予以综述,并提出目前存在的问题。     

周围性面神经损伤的诊断和治疗

周围性面神经损伤是临床常见病，表现为面部表情肌瘫痪，严重影响患者的生活质量。1991年以来，我们的课题组对周围性面神经损伤的诊断和治疗进行了较为系统的临床和实验研究，取得了—些成绩。     

局部应用糖皮质激素对大鼠面神经损伤后修复的影响

目的观察局部应用地塞米松（dexamethasone,Dex）对面神经损伤后再生修复的影响。方法健康雌性SD大鼠63只,建立大鼠面神经横断伤后端端吻合模型,分为生理盐水（normal saline,NS）对照组、地塞米松（Dex）2mg组和Dex5mg组,分别将浸泡于NS、2mg/ml及5mg/ml地塞米松磷酸钠溶液至饱和后的明胶海绵敷于各组动物的端端吻合口处。术后1、2、3、7天取远端近吻合口处神经行劳克坚牢蓝（Luxol Fast Blue,LFB）染色及ED1免疫组化染色,光镜下观察髓鞘和巨噬细胞;术后2、4、8周光镜下（锇酸染色）观察远端相同部位神经再生情况并进行轴突计数。结果光镜下观察,术后第1天髓鞘形态变化不明显,术后第2天出现明显变性崩解,至第3天崩解加快,第7天已见不到完整的髓鞘,仅余部分髓鞘碎片。术后第1天巨噬细胞数量较少,第2天开始增多,第7天较前3天显著增多。三组间髓鞘残余及巨噬细胞数量均无显著性差异（P〉0.05）。术后2周,各组均出现新生髓鞘,三组间轴突计数无统计学差异（P〉0.05）。结论本实验条件下,局部应用小剂量地塞米松对髓鞘清除速度、巨噬细胞及轴突再生数量没有明显影响。     

Bell麻痹的面神经减压疗效评价

目的 评价面神经减压术对Bell麻痹的治疗效果.方法 通过PubMed和《中国医院知识仓库》总库(简称CHKD总库)检索面神经减压治疗完全性Bell面瘫的中、英文文献,收集文中报道的病例,制定统一的准入标准,对入选病例进行统计学分析.参考激素治疗Bell面瘫的效果,评价不同的手术方法及手术时机对治疗效果的影响.结果 通过检索共有5篇文献所报道病例符合入选标准,其中手术治疗例数147例,总治愈率57.10%;激素治疗例数105例,总治愈率为48.90%.发病14天以内全程减压的手术治愈率高达90.70%,而15～30 天之间为25.00%;发病15～30 天之间面神经乳突段减压的治愈率为45.70%,全程减压治愈率为25.00%.结论 面神经减压应在发病后14天以内进行,14天以后手术治疗不能增加疗效;目前没有证据表明面神经全程减压效果优于乳突段及鼓室段面神经减压.     

面神经监测在腮腺肿瘤切除术中应用的初步观察

目的　探讨腮腺肿瘤切除术中应用神经监测对手术并发症影响。方法　将30例病例随机分为A、B两组,A组行面神经监护下腮腺浅叶或腮腺全叶切除及面神 经解剖术,B组行无面神经监护下腮腺浅叶或腮腺全叶切除及面神经解剖术。术后经0.5～3年随访,观察并发症和手术时间及出血量等情况。结果　术后并发症中皮下积液或涎瘘：A组0例（0%）,B组1例（7.1%）;面瘫：A组0,B组2例（14.3%）。Frey综合征：A组0,B组0,出血量：A组（50.3±2.4）ml,B组（75.8±2.6）ml。手术时间：A组（1.3±0.2）h,B组（1.8±0.2）h。两组并发症比较无统计学意义（P>0.05）,出血量、手术时间比较有统计学意义（P<0.05）。结论　腮腺肿瘤切除术中应用面神经监测,对面神经走形准确判断,减少手术操作,手术时间及出血量减少,有一定优越性。     

面神经损伤后糖皮质激素受体α在面神经核及外周淋巴组织的表达

目的探讨面神经损伤后,糖皮质激素受体α(GRα)在面神经核团及外周淋巴组织的表达和变化规律。方法建立新西兰兔面神经损伤模型,分别于损伤后24?h、48?h、72?h、 7?d、14?d取出面神经核团和颈部淋巴结,采用免疫组化SP法,观察糖皮质激素受体的表达情况。结果糖皮质激素受体α在面神经核团及外周淋巴细胞中均有表达;糖皮质激素受体α表达增高在面神经核中出现在损伤48?h后,颈部淋巴结出现在损伤72?h后。结论糖皮质激素受体α表达在面神经核团及外周淋巴细胞胞核及胞质中,在面神经受到损伤后其表达量增高,而且神经损伤较单纯外伤可以引起较长时间的局部炎症反应。     

Research of relationship between endoneurial fluid pressure and electroneurography of the facial nerve]

OBJECTIVE: The relationship between endoneurial fluid pressure (EFP) and electroneurography (ENoG) of the facial nerve was studied in order to evaluate the ENoG as the basis of pathophysiology of the decompression of the facial nerve. METHODS: The values of ENoG were recorded by an instrument of physiology on the normal and crushed facial nerves of guinea pigs. Endoneurial fluid pressures were measured by a servo-nulling micropipette system at the same time. After the EFP were measured, the facial nerves were removed and fixed properly for examination under the light and electron microscope in order to determine the differences from various periods after injury. RESULTS: EFP in the facial nerve was changed significantly during the period of three days to three weeks later after crushed injury, and the percentage of degenerated facial nerve fibre was the same. There was positive correlation between ENoG and EFP. After crushed injury 2 and 3 weeks, the coefficient was 0.88 and 0.51, respectively. It could be found that extensive edema in endoneurial and perivascular spaces of the facial nerve occurred in early stage of injury, but numerous Schwann cells proliferation appeared in the later period. CONCLUSION: The change of ENoG could reflect the value of EFP relatively within three weeks after crushed injury. It was suggested that ENoG could be useful in evaluating the pathogenesis underlying facial palsy. And it could be provided a basis indication for decompression of the facial nerve.     

面神经损伤后面神经内压的变化

目的研究面神经损伤后神经内压和神经直径的变化，以探讨面神经减压术的必要性以及减压时机的选择。方法采用伺服微变量系统和测微尺对面神经挤压伤后不同时期的豚鼠分别进行神经内压及神经直径的测量。结果面神经高位挤压伤后，神经内压明显改变，压力高峰期在损伤后１周末，平均可达（１２．９４±１．６９）ｍｍＨｇ，为正常值的４～５倍，神经内压的升高持续２周，至第３和第４周恢复正常。面神经直径在伤后１周末最大，平均可达（１．０１±０．０８）ｍｍ。结论伺服测压系统测量实验动物的面神经内压将有助于面瘫病理生理的研究，为临床实施面神经减压术的时机选择提供实验参考。     

A correlation study of endoneurial fluid pressure and electroneurography of the facial nerve

OBJECTIVE: The relationship between endoneurial fluid pressure (EFP) and electroneurography (ENoG) of the facial nerve was studied in order to evaluate the pathophysilogical basis of ENoG to serve as the criteria for decompression of the facial nerve. METHODS: While the values of ENoG were recorded by an instrument for physiology on the normal and crushed facial nerves of guinea pigs, EFPs were measured at the same time by a servo-nulling micropipette system. After the elevated EFP was measured, the facial nerves were removed and then fixed properly for examination under the light and electron microscope in order to determine the differences from various periods after injury. RESULTS: With the change of EFP in the facial nerve during the period from day 3 to the third week after crushed injury, the percentage of degenerated facial nerve fiber increased. There was a positive correlation between ENoG and EFP. The coefficient was 0.88 and 0.51 in the second and third week after crushed injury, respectively. Extensive edema in endoneurial and perivascular spaces of the facial nerve could be found at the early stage of injury, while proliferation of numerous Schwann cells appeared at the later stage. CONCLUSION: The change of ENoG could reflect the value of EFP relatively within 3 weeks after crushed injury. Our data indicate that ENoG could be useful to evaluate the pathogenesis underlying facial palsy.     

Interstitial fluid pressure in the facial nerve: relationship between facial nerve pressure and cerebrospinal fluid pressure

The possibility of measuring interstitial pressure in the facial nerve using a servo-nulling system was investigated. As a pilot study, interstitial fluid pressure in the extirpated medulla oblongata was measured using this system, and was found to be proportional to the pressure applied to the surrounding tissue block. Interstitial fluid pressure of the facial nerve in guinea pigs was also measurable with this system. The pressure in the facial nerve fluctuated with respiration and/or heart beat, as did CSF pressure. Respiratory fluctuations in facial nerve and CSF pressures ceased when the respirator was stopped. Facial nerve pressure appeared to be closely related to CSF pressure; the injection of saline into the CSF space resulted in an increase in facial nerve pressure. Measurement of facial nerve pressure by a servo-nulling system should be useful in evaluating the pathogenesis underlying facial palsy.     

面神经内压微创测量的实验研究

目的：研究豚鼠面神经内压的正常值。方法：采用伺服微变量测压系统对２４只正常豚鼠进行面神经内压测量。结果：正常面神经内压：鼓室段和乳突段分别为２．８７±０．５１ｍｍＨｇ和２．７０±０．４３ｍｍＨｇ,鼓室段与乳突段的面神经内压约相等,神经内压在一定范围内呈规律性波动。结论：伺服测压系统将有助于研究面瘫患者的面神经病理生理活动。     

面神经周围微血管丛分布的临床研究

目的为尽可能避免医源性面神经麻痹，评估面神经水平段周围微血管丛是否可以作为耳显微或耳神经外科术中面神经的定位标志。方法从2002年7月至2005年7月，共311例因慢性中耳炎、周围性面神经麻痹以及外耳道闭锁合并中耳畸形者，分别行开放式鼓室成形术（291例）、面神经减压术（10例）和先天性耳道闭锁和中耳畸形手术（10例）。观察和评估水平段面神经周围的微血管丛作为术中定位面神经的手术标志的有效性。结果在全部病例中，有95．8％的病例（298例）手术中可满意地观察到水平段面神经周围微血管丛，位于面神经鼓室段表面，仅4．2％的病例（13例）难以在水平段面神经周围发现该微血管丛。用面神经微血管判断水平段面神经管阳性率的95％可信区间为93．6％～98．0％。结论围绕在水平段面神经周围或表面的微血管丛，可作为术中及早且直接定位面神经的手术标志，用它来迅速确定面神经水平段是可靠的。     

Changes in endoneurial fluid pressure in the crushed facial nerve]

OBJECTIVE: To investigate the changes in endoneurial fluid pressure (EFP) and diameter of the crushed facial nerves in guinea pigs in order to determine whether there is necessity and the opportunity of the facial nerves decompression in different stage after injury. METHODS: EFP were measured using a servo-nulling micropipette system in the normal and crushed facial nerves. RESULTS: The results showed that the EFP in the facial nerve increased significantly after compression. The highest pressure of EFP 12.94 +/- 1.69 mmHg occurred at the end of the first week after injury, which was 4 to 5 times as great as that of normal ones. This change lasted about two weeks, then it returned to normal at the third or the fourth week. The largest diameter of the facial nerve 1.01 +/- 0.08 mm was seen at the end of the first week after crush injury. CONCLUSION: It suggested that the servonulling micropiette system was useful in evaluating the pathogenesis of facial palsy. It could provide the laboratory basis for facial nerve decompression.