面神经电图和肌电图在面瘫中的预后价值。

Prognostic value of electroneurography and electromyography in facial palsy.

作者信息

Grosheva Maria, Wittekindt Claus, Guntinas-Lichius Orlando

机构信息

Department of Otorhinolaryngology, Head and Neck Surgery, University of Cologne, Cologne, Germany.

出版信息

Laryngoscope. 2008 Mar;118(3):394-7. doi: 10.1097/MLG.0b013e31815d8e68.

DOI:10.1097/MLG.0b013e31815d8e68

PMID:18090862

Abstract

OBJECTIVES

To compare the prognostic value of electroneurography (ENG) and needle electromyography (EMG) to estimate facial function outcome after acute facial palsy.

STUDY DESIGN

Retrospective study using electrodiagnostic data and medical chart review.

METHODS

Two hundred one patients treated 1995 to 2004 were included. Initial and final facial function was established clinically by the House-Brackmann (HB) scale. ENG results were classified into amplitude loss less than 75% and amplitude loss 75% or greater to predict complete recovery and defective healing, respectively. Initial and follow-up EMG results were classified into neurapraxia and predicted complete recovery. In contrast, axonotmesis/neurotmesis and mixed lesions predicted, by definition, defective healing.

RESULTS

: Initial HB was II to IV in 154 patients and V to VI in 47 patients. The etiology was idiopathic palsy in 139, iatrogenic lesion in 29, traumatic in 18, and herpes zoster in 15 patients. Finally, 134 (67%) patients showed a full recovery. Sixty-seven (33%) patients showed signs of defective healing. ENG presented a sensitivity, specificity, accuracy, positive predictive value (to predict defective healing), and negative predictive value of 60%, 79%, 73%, 59%, and 80%, respectively. The values for the initial EMG were 66%, 98%, 89%, 91%, and 89%. The best results showed the follow-up EMG with 85%, 100%, 97%, 100%, and 96%. EMG results were not classifiable in 32 (16%) patients.

CONCLUSIONS

EMG showed higher prognostic values than ENG, especially when repeated during the time course of the facial palsy. ENG might be helpful if the EMG result is not classifiable.

摘要

目的

比较神经电图（ENG）和针极肌电图（EMG）在评估急性面瘫后面部功能预后方面的价值。

研究设计

利用电诊断数据和病历回顾进行的回顾性研究。

方法

纳入1995年至2004年接受治疗的201例患者。初始和最终面部功能通过House-Brackmann（HB）量表进行临床评估。ENG结果分为幅度损失小于75%和幅度损失75%或更高，分别用于预测完全恢复和愈合不良。初始和随访的EMG结果分为神经失用，并预测完全恢复。相比之下，轴突断裂/神经断裂和混合性病变根据定义预测愈合不良。

结果

154例患者初始HB分级为II至IV级，47例患者为V至VI级。病因包括特发性面瘫139例、医源性损伤29例、创伤性18例、带状疱疹15例。最终，134例（67%）患者完全恢复。67例（33%）患者有愈合不良的迹象。ENG的敏感性、特异性、准确性、阳性预测值（预测愈合不良）和阴性预测值分别为60%、79%、73%、59%和80%。初始EMG的值分别为66%、98%、89%、91%和89%。随访EMG的最佳结果为85%、100%、97%、100%和96%。32例（16%）患者的EMG结果无法分类。