CAJ | 학술논문

目的研究神经血管减压、肌肉切断和肉毒素治疗痉挛性斜颈(ST)的差别.探讨ST的真正发病原因、寻找治疗ST的有效方法 .方法选择9例经过其他方法治疗无效而且不愿意行肌肉切断的ST患者,经过临床、神经影像学和神经电生理检查后行副神经血管减压术.把神经血管减压治疗ST的结果与采用肌肉切断方法治疗的13例患者、采用肉毒素治疗的22例患者结果进行比较.结果 22例应用肉毒素和其他药物治疗的患者在初期症状会有所缓解,但是数月后又逐渐加重,无一例能够治愈.13例患者接受1～2次、一侧或双侧痉挛性肌肉切断术,4例痉挛症状在术后得到明显改善,9例患者改善较少.肌肉切断后的患者均有不同程度的颈部运动功能障碍.9例患者选择行神经血管减压,术中发现都有严重的血管压迫.5例在神经血管减压后的2～14 d症状得到明显改善,术后3、6个月复查时疗效稳定,都恢复了正常的工作和生活;4例在神经血管减压后的早期症状有部分改善,在3个月时症状得到进一步的改善,至6个月时疗效稳定都恢复了正常的工作和生活.神经血管减压术无病死率,无脑脊液漏、感染、脑挫伤、出血和神经损伤等并发症.结论血管压迫副神经可能是引起ST的重要原因之一,行副神经血管减压对一些ST确有疗效.但是要判断哪些患者是神经血管减压的适应证却非常困难.因此严格筛选和掌握手术指征、建立手术前后客观评价疗效标准和筛选方法非常重要.
목적 연구신경혈관감압、기육절단화육독소치료경련성사경(ST)적차별.탐토ST적진정발병원인、심조치료ST적유효방법 .방법 선택9례경과기타방법 치료무효이차불원의행기육절단적ST환자,경과림상、신경영상학화신경전생리검사후행부신경혈관감압술.파신경혈관감압치료ST적결과 여채용기육절단방법 치료적13례환자、채용육독소치료적22례환자결과 진행비교.결과 22례응용육독소화기타약물치료적환자재초기증상회유소완해,단시수월후우축점가중,무일례능구치유.13례환자접수1～2차、일측혹쌍측경련성기육절단술,4례경련증상재술후득도명현개선,9례환자개선교소.기육절단후적환자균유불동정도적경부운동공능장애.9례환자선택행신경혈관감압,술중발현도유엄중적혈관압박.5례재신경혈관감압후적2～14 d증상득도명현개선,술후3、6개월복사시료효은정,도회복료정상적공작화생활;4례재신경혈관감압후적조기증상유부분개선,재3개월시증상득도진일보적개선,지6개월시료효은정도회복료정상적공작화생활.신경혈관감압술무병사솔,무뇌척액루、감염、뇌좌상、출혈화신경손상등병발증.결론 혈관압박부신경가능시인기ST적중요원인지일,행부신경혈관감압대일사ST학유료효.단시요판단나사환자시신경혈관감압적괄응증각비상곤난.인차엄격사선화장악수술지정、건립수술전후객관평개료효표준화사선방법 비상중요.
Objective To compare the effects of treatment of spasmodic torticollis (ST) by neurovascular decompression, myotomy, and botulinum toxin type A and to investigate the mechanism of ST. Methods Nine ST patients who failed to respond to other conservative treatment methods underwent neurovascular decompression of accessory nerve. The effect of decompression was compared with that by botulinum toxin in 22 patients and that by myotomy in 13 patients. Results The symptoms and signs were improved to a certain degree by botulinum toxin treatment at first, but recurred and gradually worsened in several months. None of the 22 patients had reached a real cure by botulinum toxin type A treatment. Four of 13 patients undergoing myotomy improved a lot in the symptoms and 9 improved only a bit. However, weakness in neck movement was found in all patients after myotomy. Neurovascular decompression was performed on 9 patients, 5 of which had had botulinum toxin treatment and 1 had undergone myotomy, and found that all of them had severe vascular compression in the accessory nerve. Obvious alleviation of symptoms was achieved 2 ～ 14 days after the operation in 8 patients, and 3 months later in 1 patient. All of the 9 patients resumed their normal work and life 6 months after the operation. No complication, such as nerve damage, infection, hemorrhage, leakage of eerebrospinal fluid, and weakness of neck, was found. Conclusions Neurovascular compression may be the most important cause of ST. Microneurovascular decompression is effective for some patients. However, it is still difficult to judge its indication.