Taira T, Mitsuyama T, Okami N, Yoneyama T, Imamura T, Iseki H, Takakura K
Department of Neurosurgery, Tokyo Women's Medical University.
No Shinkei Geka. 1999 Jan;27(1):25-31.
Patients with laterocollis or rotatory type torticollis tend to show abnormal contraction of the levator scapulae muscle and the scalene muscles. These muscles are innervated from the anterior branches of the cervical spinal nerves. Because of this, the traditional Bertrand operation dealing with posterior branches does not adequately affect the symptoms of laterocollis. The authors report selective denervation of the levator scapulae muscle in three patients and discuss its rationale. All the three patients underwent denervation of both the C1-C6 posterior spinal rami and the branches from the C3 and C4 anterior rami to the levator scapulae muscle. We added myotomy of the scalene muscle in one patient, and denervation of the omohyoid muscle which is innervated from the ansa cervicalis and the descending branch of the hypoglossal nerve. The pre/post-operative Tsui scores were 12/4, 15/1, and 14/3 respectively. There were no complications. We conclude that selective peripheral denervation of the levator scapulae muscle is safe and effective in the treatment of laterocollic type torticollis.
患有斜颈或旋转型斜颈的患者往往表现出肩胛提肌和斜角肌的异常收缩。这些肌肉由颈脊神经前支支配。因此，传统的处理后支的伯特兰手术不能充分缓解斜颈症状。作者报告了对3例患者进行肩胛提肌选择性去神经支配，并讨论了其理论依据。所有3例患者均接受了C1 - C6脊神经后支以及C3和C4前支至肩胛提肌分支的去神经支配。我们在1例患者中增加了斜角肌肌切开术，并对由颈袢和舌下神经降支支配的肩胛舌骨肌进行了去神经支配。术前/术后的崔氏评分分别为12/4、15/1和14/3。无并发症发生。我们得出结论，肩胛提肌选择性周围神经去神经支配在治疗斜颈型斜颈方面是安全有效的。
