显微神经外科手术治疗痉挛性斜颈137例分析

目的探讨显微神经外科手术治疗痉挛性斜颈（ST）的疗效。方法对137例ST患者采用显微手术治疗，针对病例的不同情况分别采用改良Foerster—Dandy手术（126例）、副神经周围支切断及胸锁乳突肌选择性切除术（9例）、经颅副神经根切断术（2例）治疗。结果全部患者术后平均随访44．9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93．4％（128／137）。行改良Foerster-Dandy手术的126例术后均发生不同程度转颈无力、耸肩无力、双臂外展受限，随访期间有所好转，仅2例（1．6％）发生头颈部支撑困难；36例（28．6％）发生不同程度吞咽困难，随访期间恢复正常18例，明显好转11例，无明显变化7例（5．6％）；颅内感染10例（7．9％），出院前均治愈。随访期间痉挛状态不同程度复发9例（6．6％）。结论选择合适病例、针对病例的不同情况采用不同手术方法、熟悉局部解剖、掌握显微手术技巧是保证显微外科手术治疗ST效果、减少并发症的关键。

Microneurosurgery for Spasmodic Tortcollis(a Report of 137 cases)

Objective To explore the curative effect of microneurosurgery on spasmodic torticollis. Methods The microneurosur-gery including modified Foerster-Dandy operation(126 cases), the selective neurotomy of peripheral branches of the accessory nerves and cutting off the partial sternocleidomastoid muscles(9 cases), and intracranial neurotomy of accessory nerve roots(2 cases) was performed from July, 2001 to July, 2008 in 137 patients with spasmodic torticollis. Their clinical data were analyzed retrospectively. Results The spasticity was relieve immediately after the operation in all the patients. All the patients were averagely followed up for 44.9 months after the surgery. The relief rate of the spasticity was 93.4% (128/137) during the following-up period. Postoperative complications in 126 patients undergoing modified Foerster-Dandy operation included transient weakness of neck, arms and shoulder in 124 cases, their persistent severe weakness in 2 cases, dysphagia in different degree in 36 cases, in whom, dysphagia disappeared in 18 cases, dysphagia was significantly relieved in 11, and unchanged in 7 during the following-up period, and postoperative intracranial infection in 10 cases.The spasticity recurred in 9 patients during the following-up period. Conclusions The strict grasping of surgical indication, individualized surgical method, understanding of regional microanatomy and microsurgical techniques were keys to gaining good effects and lowering postoperative complication rates in the patients with spasmodic torticollis undergoing neuresurgery.