自体静脉套吻合端套管内注入脑细胞生长肽对面神经损伤功能恢复的作用

背景面神经损伤后功能恢复需要较长时间,如何加速面神经的功能恢复是该领域正在研究的课题.目的比较面神经损伤修复的不同方法,探讨自体静脉套接吻合口及脑细胞生长肽在临床上修复面神经损伤的效果.设计以诊断为依据的病例对照研究.地点和对象中国医科大学附属第一医院1999-01/2001-12收治44例面神经损伤患者和1999-01以前收治面神经损伤患者30例.干预对44例创伤后和腮腺区恶性肿瘤切除造成的面神经损伤患者,在手术显微镜下行神经断端对位吻合,将自体静脉管套入吻合口并在管套内注入脑细胞生长肽.对30例面神经损伤患者采用传统神经端吻合法修复,术后不同时间观察面部表情肌功能恢复及肌电图的动态变化.主要观察指标观察面部表情肌功能恢复的时间,检测面神经传导速度的动态变化.结果30例创伤性面神经损伤患者,功能恢复最快9周,最迟13周,平均(11.1±1.1)周,与传统方法(25.8±1.8)周比较有显著性差异(t=34.875,P＜0.01);14例肿瘤切除面神经立即修复的患者,功能恢复最快13周,最迟15周,平均(13.8±0.8)周,与传统方法(34.8±2.9)周比较有显著性差异(t=26.336,P＜0.01).肌电图检测面神经传导速度的恢复呈递增趋势,表情肌功能恢复时两种方法传导速度比较无显著性差异(P＞0.05).结论自体静脉管套入吻合口并注入脑细胞生长肽的方法均比传统方法效果显著,是一种临床效果比较突出的面神经损伤修复方法.

Effect of injecting brain cell growth peptide into conduit at the anastomose end of autogenous vein graft conduit on functional rehabilitation of facial nerve injury

BACKGROUND: Functional rehabilitation requires longer time after facial nerve injury. How to speed up the functional rehabilitation of facial nerve is a topic in this academic field.OBJECTIVE: To discuss the effect of autogenous vein graft conduit anastomose and brain cell growth peptide(BCGP) on clinical rehabilitation of facial nerve injury by comparing different methods in the rehabilitation of facial nerve injury.DESIGN: A case-control study based on diagnosis.SETTING and PARTICIPANTS: Forty-four facial nerve injury patients admitted into the first affiliated hospital of China Medical University from January 1999 to December 2001 and 30 facial nerve injury patients admitted before January 1999 were selected.INTERVENTIONS: Forty-four facial nerve injury patients caused by trauma broken end anastomoses under surgical microscope. Autogenous vein conduit was capped into anastomose and moreover, BCGP was injected into the conend anastomose rehabilitation. The functional recovery of facial expression muscle over time after surgery and the dynamic changes in electromyography(EMG) were observed.MAIN OUTCOME MEASURES: The rehabilitation time of facial expression muscle function was observed and the dynamic changes of conduction velocity of facial nerve were assayed.RESULTS: In 30 traumatic facial nerve injury patients, the fastest function recovery was at 9 weeks and the latest was at 13 weeks with a mean of(11.1 ± 1.1) weeks, which had significance compared with that(25.8 ±1.8) weeks of traditional method ( t = 34. 875, P ＜ 0. 01 ) . In 14 tumor remoral with immediate restoration of facial nerve patients, the fastest function recovery was at 13 weeks and the latest was at 15 weeks with a mean of(13.8 t0. 8) weeks, which had significance in the comparison with that(34. 8 ±2.9) weeks of traditional method( t =26. 336, P ＜ 0. 001) . There was an increasing tendency in conduction velocity(CV) of facial nerve in the test of EMG, and there was no significant difference of CV between two methods when the function of facial expression muscle recovered ( P ＞ 0. 05).CONCLUSION: There is more significant effectiveness of the method of injecting brain cell growth peptide into conduit at the anastomose end of autogenous vein graft conduit compared with traditional method, which is a restoration method in facial nerve injury with more outstanding clinical effectiveness.