Norfolk, Va. From the Department of Surgery, Division of Plastic Surgery, the International Institute of Reconstructive Microsurgery, and the Graduate Program in Public Health, Epidemiology and Biostatistics, Eastern Virginia Medical School.
Plast Reconstr Surg. 2009 Nov;124(5):1499-1512. doi: 10.1097/PRS.0b013e3181babb93.
To improve the ability to prognosticate the final surgery outcomes, this study was carried out to explore the correlation between the number of motor axons given to cross-facial nerve grafts for smile restoration and the aesthetic and functional outcomes.
Sixty-nine cases had adequate nerve biopsy specimens and were selected for the authors' study. Patient information was collected from chart review. Using Terzis' evaluation scale, smile functional and aesthetic outcomes as depicted in standardized videos were graded by a panel of four independent reviewers. Digital images of nerve specimens in stages I and II were obtained by using a microscope with a digital camera attachment. Using MetaMorph software, the number of motor axons was calculated, with the exception of the nerve specimens at the distal nerve grafts in stage II, which were quantitated manually. Mann-Whitney and Fisher's exact tests were used to test the effects of axon numbers and other factors on the outcomes.
The donor axonal input correlated with the axon number at the distal end of the nerve graft and also correlated with the improvement of evaluation; however, no significance was found between the counts at the distal end of the nerve graft and the clinical outcomes. An important observation was that patients with a donor nerve count of 900 or higher showed a greater likelihood of achieving satisfactory results.
The axon count at the donor nerve has a stronger influence on the final results.
为了提高对最终手术结果的预测能力，本研究旨在探讨用于恢复微笑的跨面神经移植术中给予的运动轴突数量与美学和功能结果之间的相关性。
69 例有足够神经活检标本的患者被纳入作者的研究。通过病历回顾收集患者信息。使用 Terzis 评估量表，由四名独立评审员对标准化视频中的微笑功能和美学结果进行评分。使用带有数字相机附件的显微镜获得 I 期和 II 期神经标本的数字图像。使用 MetaMorph 软件计算运动轴突的数量，除了 II 期神经移植物远端的神经标本需要手动定量外。使用 Mann-Whitney 和 Fisher 精确检验测试轴突数量和其他因素对结果的影响。
供体轴突输入与神经移植物远端的轴突数量相关，也与评估的改善相关；然而，在神经移植物远端的计数与临床结果之间未发现显著相关性。一个重要的观察结果是，供体神经计数为 900 或更高的患者更有可能获得满意的结果。
供体神经中的轴突计数对最终结果有更强的影响。
