中华耳科学杂志

目的探讨经乳突-上鼓室入路面神经减压术治疗颞骨外伤性面瘫的手术适应症、手术时机、效果以及影响预后的因素。方法回顾性总结2008-2014年于解放军总医院经乳突-上鼓室入路行面神经减压术治疗颞骨外伤性面瘫的99例(102侧)临床资料,分析骨折类型与听力损失的关系;按骨折类型和术前病程分组,以House-Brackmann(HB)分级标准评估手术效果,随访至面神经功能正常或1年以上,对随访资料完整的70例(73侧)的疗效进行总结,统计方法采用SPSS17.0统计软件进行Spearman相关分析及χ2检验。结果 99例(102侧)外伤的原因:交通事故55例(58侧),跌伤20例,坠物砸伤17例,其他7例;颞骨骨折68例(71侧),其中纵行骨折56例(59侧),横行骨折12例,传导性耳聋在纵形骨折和横行骨折中的发生率分别为37.3%和16.7%,差异无统计学意义(P=0.169),感音神经性耳聋在横行骨折中的发生率为66.7%,明显高于其在纵行骨折中的发生率18.6%(P=0.001);资料完整的70例(73侧)面瘫患者术前面神经功能:Ⅳ级4例,Ⅴ级48例(49侧),Ⅵ级18例(20侧),术后面神经功能:Ⅰ级24例(27侧),Ⅱ级32例,Ⅲ级13例,Ⅳ级1例,骨折类型分组在面神经功能恢复上差异无统计学意义(P=0.478),术前病程越短,面神经功能恢复越好(rs=0.257,P=0.026),术前病程在2个月内者面神经功能恢复至Ⅰ级或Ⅱ级者为87.8%,手术效果优于术前病程2个月以上者,差异有统计学意义(P=0.032)。结论交通事故导致的颞骨骨折是造成外伤性面瘫的主要原因,经乳突-上鼓室入路面神经减压术是治疗外伤性面瘫的一种有效的治疗手段,手术效果与面神经损伤的术前病程有关,应尽早手术,外伤后2个月内手术效果较好。

Objective To study operation indications, optimal timing and final facial function outcomes in patients with traumatic facial paralysis in relation to surgery timing. Methods We performed a retrospective review of 99 cases(102sides) of tramatic facial paraiysis who underwent facial never depression via a mastoid-epitympanum approach, and analyzed the relation between fracture type and hearing loss. Patients were classified by fracture type and time before surgery and 70 cases(73 sides) with complete data were summarized. The House-Brackmann(H-B) grading scale was used to evaluate facial nerve function pre-and post-operation. Spearman test and χ2 test were employed for stastistic analysis. Results Causes of traumatic facial paralysis in this group of cases included traffic accidents(n=55, 58 sides), falls(n=20), crashes(n=17) and others(n= 7). Temporal bone fracture was identified in 68 cases(71 sides), including both longitudinal(n=56,59 sides) and transverse(n=12) fractures. The incidences of conductive hearing loss in cases with longitudinal(37.3%) and transverse(16.7%) fractures were not statistically different(P=0.169). The incidence of sensorineural hearing loss in transverse fractures(66.7%) was significantly higher than in longitudinal fractures(P=0.001). Varying degrees of facial function improvement were noticed during following up, and showed no difference among subgroups classified by fracture types(P=0.478), although there was a close relationship between facial nerve function recovery grade and the course of nerve injury(r=0.257, P=0.026). The rate of good recovery to H-B 1 or 2 in patients undergoing decompression surgery within 2 months after trauma was 87.8%(43/49), better than that of patients undergoing late decompression(P=0.032). Conclusion Traffic crashes continue to be the main cause of traumatic facial paralysis. Facial nerve decompression is an effective management for traumatic facial paralysis. Facial function recovery is correlated with the course of facial nerve trauma. Facial nerve decompression should be carried out as soon as possible and better recovery is expected if the surgery is performed within 2months.