异常肌反应在面肌痉挛微血管减压术中的应用

目的 探讨术中监测异常肌反应（abnormal muscle response，AMR）在面肌痉挛微血管减压（microvascular decompression， MVD）手术中的应用价值。方法 回顾性分析杭州市第一人民医院于2012年1月~2016年4月收治的575例患者，根据手术方式分为两组：未在AMR监测下行MVD手术257例（MVD组），在术中AMR全程监测下行MVD手术318例（MVD+AMR组）。对比两组术后近期（术后1周）和远期（术后1年）疗效与并发症。结果 MVD组：术后1周患者疗效：治愈181例（70.4%），缓解72例（28.0%），无效4例（1.56%）；术后1年患者疗效：治愈230例（89.5%），缓解24例（9.34%），无效3例（1.17%）；术后并发症：听力下降11例，轻度面瘫4例。MVD+AMR组：术后1周患者疗效：治愈266例（84.1%），缓解50例（14.7%），无效2例（0.63%）；术后1年患者疗效：治愈297例（93.4%），缓解19例（5.97%），无效2例（0.63%）；术后并发症：听力下降4例，轻度面瘫3例。两组近期手术疗效比较差异有统计学意义（P<0.05），远期疗效比较差异无统计学意义（P>0.05），两组并发症比较差异无统计学意义（P>0.05）。结论 术中监测AMR有助于判断责任血管，并且在AMR监测下对面神经进行全程探查减压能够提高近期手术疗效，但不能认为AMR的应用可以提高远期疗效。

Application of Abnormal Muscle Response Monitoring to Microvascular Decompression for Hemifacial Spasm

Objective To investigate the value of intraoperative abnormal muscle response (AMR) during the microvascular decompression (MVD) for hemifacial spasm (HFS). Methods Totally 575 patients in total were analyzed retrospectively between January 2012 and April 2016. The patients were diviede into two groups:257 patients received MVD surgery without AMR monitoring(MVD group), 318 patients received MVD surgery with continuous AMR monitoring(MVD+AMR group). The short-term prognosis(1 week after operation) and the long-term prognosis (1 year after operation) were analyzed comparatively. Results Group A:The short-term prognosis showed that the symptoms completely disappeared in 181 patients(70.4%),significantly relieved in 72 patients(28.0%),had little change in 4 patients(1.56%).The long-term prognosis showed that the symptoms completely disappeared in 230 patients(89.5%),significantly relieved in 24 patients(9.34%),had little change in 3 patients(1.17%). The complications included 11 patients of hearing reduction and 3 patients of mild facial paralysis. Group B:The short-term prognosis showed that the symptoms completely disappeared in 266 patients(84.1%),significantly relieved in 50 patients(14.7%),had little change in 2 patients(0.63%),the long-term prognosis showed that the symptoms completely disappeared in 297 patients(93.4%),significantly relieved in 19 patients(5.97%),had little change in 2 patients(1.17%). The complications included 4 patients of hearing reduction and 3 patients of mild facial paralysis. Conclusion The statistical analysis indicated that Group B had a significantly better short-term prognosis than Group A (P<0.05). There was no significant difference between the long-term prognosis and complication rate of two groups (P>0.05).