痉挛性斜颈的外科治疗及其相关解剖特点

摘要

Objective To summarize the clinical classification,related anatomy,surgical treatment and clinical effects of spasmodic tor-ticollis(ST).Methods The clinical data of 62 patients with ST were analyzed retrospectively.All the patients were classified accord-ing to the scope of involvement,torticollis posture,muscle spasms,and degree of illness.The operative mode was depended on the torti-collis posture of ST,including selective resection of posterior cervical spasmodic muscle,selective neurotomy of the posterior branches of the ipsilateral cervical nerve 1-6 and accessory neurotomy.Surgical outcomes were evaluated by the toronto western spasmodic torticollis rating scale(TWSTRS).Results All the patients were followed up for 7-12(10.6 ±1.2)months.The operation efficiency was 87.1%.No serious complications and secondary disease occurred.The clinical effect of the patients with CT scan and electromyography was significantly better than those without CT scan and electromyography(P<0.05).The postoperative efficacy of simple ST,rotatory and lateral flexion ST were superior to symptomatic,hybrid ST rotating,respectively(P<0.05).Conclusions Surgery treatment can effectively treat ST,alleviate symptoms of the neck,but needs to combine patients′clinical classification,state of illness,improve the preoperative EMG and CT examination,know about local anatomical features to take individualized treatment plan.%目的 总结痉挛性斜颈(ST)的临床分型、相关解剖特点、外科治疗方法及临床效果.方法 回顾性分析62例ST患者的临床资料,对患者分别按照痉挛肌肉累及范围、斜颈姿态、肌肉痉挛方式及病情程度分型,并根据斜颈姿态采用相应的术式组合,包括痉挛肌肉选择性切除术、颈神经1-6(C1-6)后支选择性切断术、副神经切断术,术后采用TWSTRS 评分以判断手术效果.结果 所有患者随访7~12(10.6 ±1.2)个月,手术有效率为87.1%,均无严重并发症及继发症发生.术前行CT检查、肌电图检查患者的疗效显著优于未行检查者(P<0.05);单纯性ST的术后疗效显著优于症状性ST,旋转型、侧屈型ST的术后疗效显著优于混合型ST(P<0.05).结论 外科手术可有效治疗ST,缓解颈部症状,但需结合患者的临床分型、病情,完善术前肌电图与CT检查,局部解剖特点采取个体化的治疗方案.