摘要
目的探讨改良Foerster-Dandy手术治疗痉挛性斜颈(ST)患者的长期疗效及并发症。方法回顾性纳入2005年4月至2013年4月中日友好医院神经外科收治的550例ST患者,均行改良Foerster-Dandy手术治疗,即采用枕颈部后正中入路,不打开枕鳞及枕骨大孔,予限制性椎板切除,内镜辅助下行硬膜下双侧副神经、C1脊神经根切断术,C2 ~C4脊神经前、后根选择性部分切断术。采用Tsui量表评估手术疗效,并对术后并发症进行分析。结果所有患者随访60~156个月,平均(117.0±5.5)个月。术后6个月、12个月及末次随访时的痉挛改善率分别为73.6%(54.7%,86.4%)、70.2%(48.8%,85.1%)、73.2%(51.1%,88.5%)。550例患者的术前Tsui评分为17.2(13.6,20.6)分,术后6个月、12个月及末次随访时的Tsui评分分别为4.6(2.2,7.3)分、4.9(2.6,8.1)分以及4.3(2.0,7.5)分,较术前评分均明显降低(均P<0.05)。术后出现转颈无力30例(5.5%),耸肩无力34例(6.2%),双臂外展受限32例(5.8%),长期颈背部疼痛及麻木45例(8.2%),颈围变细11例(2.0%),吞咽困难62例(11.3%)。其中5例转颈无力及9例吞咽困难无明显改善,其余并发症经康复训练均有好转。随访期间25例患者(4.5%)的痉挛症状复发。结论改良Foerster-Dandy手术是治疗ST安全、长期有效的外科手段。
Objective To investigate the long-term efficacy and complications of modified Foerster-Dandy operation in the treatment of spasmodic torticollis (ST). Methods A total of 550 cases of ST admitted to Neurosurgery Department of China-Japan Friendship Hospital from April 2005 to April 2013 were retrospectively enrolled into this study. All patients were treated with modified Foerster-Dandy operation, in which occipitocervical posterior median approach was used without opening of occipital squama and foramen magnum. Limited laminectomy, endoscope-assisted bilateral subdural accessory nerve and C1 spinal nerve root cutting and selective partial cutting of anterior and posterior roots of C2-4 spinal nerve were conducted. The international Tsui scale was used to evaluate the efficacy post operation. We also analyzed the complications occurring following the operations. Results All patients were followed up for 60-156 months, with an average of 117.0±5.5 months. The median improvement rate of spasticity at 6 months, 12 months and the latest follow-up was 73.6% (54.7%, 86.4%), 70.2% (48.8%, 85.1%) and 73.2% (51.1%, 88.5%), respectively. The Tsui score before operation was 17.2 (13.6, 20.6). However, at 6 months, 12 months and the latest follow-up, the Tsui scores were 4.6 (2.2, 7.3), 4.9 (2.6, 8.1) and 4.3 (2.0, 7.5), respectively, which were significantly lower than those prior to operation (all P<0.05). However, 30 (5.5%) cases had neck rotation weakness, 34 (6.2%) reported shoulder shrug weakness, 32 (5.8%) had limited arms abduction, 45 (8.2%) developed long-term neck back pain and numbness, 11 (2.0%) reported neck circumference narrowing, and 62 (11.3%) suffered from dysphagia. Among them, no obvious improvement was achieved in 5 cases with neck rotation weakness and 9 cases with dysphagia. All the other complications were relieved to various degrees during the follow-up period after rehabilitation training. During the follow-up, spasm recurrence to various degrees was reported in 25 (4.5%) cases. Conclusion Modified Foerster-Dandy operation is a safe and effective surgical therapy for patients with ST.
作者
刘红举
于炎冰
任鸿翔
许骏
徐晓利
张黎
Liu Hongju;Yu Yanbing;Ren Hongxiang;Xu Jun;Xu Xiaoli;Zhang Li(Department of Neurosurgery,China-Japan Friendship Hospital,Beijing 100029,China)
出处
《中华神经外科杂志》
CSCD
北大核心
2019年第1期6-9,共4页
Chinese Journal of Neurosurgery
