Sun Ke-Hua, Lu Yi-Cheng, Hu Guo-Han, Luo Chun, Hou Li-Jun, Chen Ju-Xiang, Zhou Jian
Department of Neurosurgery and Shanghai Institute of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China.
Zhonghua Yi Xue Za Zhi. 2009 Jan 6;89(1):21-4.
To compare the effects of treatment of spasmodic torticollis (ST) by neurovascular decompression, myotomy, and botulinum toxin type A and to investigate the mechanism of ST.
Nine ST patients who failed to respond to other conservative treatment methods underwent neurovascular decompression of accessory nerve. The effect of decompression was compared with that by botulinum toxin in 22 patients and that by myotomy in 13 patients.
The symptoms and signs were improved to a certain degree by botulinum toxin treatment at first, but recurred and gradually worsened in several months. None of the 22 patients had reached a real cure by botulinum toxin type A treatment. Four of 13 patients undergoing myotomy improved a lot in the symptoms and 9 improved only a bit. However, weakness in neck movement was found in all patients after myotomy. Neurovascular decompression was performed on 9 patients, 5 of which had botulinum toxin treatment and 1 had undergone myotomy, and found that all of them had severe vascular compression in the accessory nerve. Obvious alleviation of symptoms was achieved 2 - 14 days after the operation in 8 patients, and 3 months later in 1 patient. All of the 9 patients resumed their nonenal work and life 6 months after the operation. No complication, such as nerve damage, infection, hemorrhage, leakage of cerebrospinal fluid, and weakness of neck, was found.
Neurovascular compression may be the most important cause of ST. Microneurovascular decompression is effective for some patients. However, it is still difficult to judge its indication.
比较神经血管减压术、肌切开术及A型肉毒毒素治疗痉挛性斜颈（ST）的效果，并探讨ST的发病机制。
9例对其他保守治疗方法无效的ST患者接受副神经血管减压术。将减压效果与22例接受肉毒毒素治疗的患者及13例接受肌切开术的患者的效果进行比较。
肉毒毒素治疗初期症状和体征有一定程度改善，但数月后复发并逐渐加重。22例患者中无1例通过A型肉毒毒素治疗达到真正治愈。13例行肌切开术的患者中，4例症状明显改善，9例仅稍有改善。然而，所有患者术后均出现颈部活动无力。对9例患者进行了神经血管减压术，其中5例曾接受肉毒毒素治疗，1例曾行肌切开术，发现所有患者副神经均有严重血管压迫。8例患者术后2 - 14天症状明显缓解，1例3个月后缓解。9例患者术后6个月均恢复正常工作和生活。未发现神经损伤、感染、出血、脑脊液漏及颈部无力等并发症。
神经血管压迫可能是ST最重要的病因。微血管减压术对部分患者有效。然而，其适应证仍难以判断。
