Urso-Baiarda F, Grobbelaar A O
Restoration of Appearance and Function Trust, Leopold Muller Building, Mount Vernon Hospital, Northwood, Middlesex, UK.
J Plast Reconstr Aesthet Surg. 2009 Aug;62(8):1042-7. doi: 10.1016/j.bjps.2008.01.008. Epub 2008 Jun 30.
Functional muscle transfer (FMT) combined with cross-facial nerve grafting (CFNG) is the gold standard treatment of chronic unilateral facial palsy, performed by most surgeons over two operative stages to minimise FMT denervation atrophy. Proponents of one-stage surgery cite shorter total recovery time, fewer operative procedures and a possible beneficial neurotrophic effect of muscle attachment. This study aimed to compare one- and two-stage surgery in terms of neural and muscle reinnervation and FMT force production. Forty New Zealand white rabbits underwent one- or two-stage rectus femoris FMT and interposed nerve grafting under different reinnervation conditions. For two-stage surgery, nerve grafting was followed by FMT after three months and by final experiments after a further six months, whereas one-stage groups experienced nerve grafting and FMT together and final experiments after nine months. Outcomes compared were nerve graft and rectus nerve morphometry, FMT reinnervation measured using PGP 9.5, and FMT force production. Statistical analysis was performed by means of the independent samples t-test or the Mann-Whitney Rank Sum test using Statistics Package for the Social Sciences version 11.0.4 for Mac OS X. Nerve graft reinnervation was similar for respective one- and two-stage surgery groups or favoured one-stage surgery. There was no significant difference between respective groups in terms of rectus nerve morphometry, muscle reinnervation, or absolute, weight-adjusted or weight- and control-adjusted tetanic force production. One-stage surgery offers potential advantages including a reduction in the number of surgical procedures, a shorter total recovery time and beneficial economic and healthcare delivery implications. This data supports previous clinical and experimental studies and questions the basis for performing facial reanimation by FMT combined with CFNG over two separate operative stages.
功能性肌肉转移（FMT）联合跨面神经移植（CFNG）是慢性单侧面瘫的金标准治疗方法，大多数外科医生分两个手术阶段进行，以尽量减少FMT去神经萎缩。一期手术的支持者认为总恢复时间更短、手术程序更少，且肌肉附着可能具有有益的神经营养作用。本研究旨在比较一期和二期手术在神经和肌肉再支配以及FMT力量产生方面的差异。40只新西兰白兔在不同的再支配条件下接受了一期或二期股直肌FMT及植入神经移植。对于二期手术，在三个月后进行神经移植，然后进行FMT，再过六个月进行最终实验，而一期手术组在九个月内同时进行神经移植和FMT并进行最终实验。比较的结果包括神经移植和股直神经形态学、使用PGP 9.5测量的FMT再支配以及FMT力量产生。使用适用于Mac OS X的社会科学统计软件包版本11.0.4，通过独立样本t检验或曼-惠特尼秩和检验进行统计分析。一期和二期手术组各自的神经移植再支配情况相似，或一期手术更具优势。在股直神经形态学、肌肉再支配或绝对、体重调整或体重及对照调整的强直收缩力产生方面，各组之间没有显著差异。一期手术具有潜在优势，包括减少手术程序数量、缩短总恢复时间以及对经济和医疗服务提供产生有益影响。这些数据支持了先前的临床和实验研究，并对通过FMT联合CFNG分两个独立手术阶段进行面部重建的依据提出了质疑。
