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游离功能性肌肉移植面神经麻痹修复中单一与双重神经支配的系统评价与Meta分析

Single versus dual innervation in facial palsy reanimation with free functional muscle transfers: a systematic review and meta-analysis.

作者信息

Brader Andrin S, Leckenby Jonathan, Grobbelaar Adriaan O, Zubler Cédric

机构信息

Department of Plastic and Hand Surgery, Inselspital University Hospital Bern, University of Bern, Freiburgstrasse 18, Bern, Switzerland.

Department of Surgery, Division of Plastic Surgery, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY 14642, USA.

出版信息

JPRAS Open. 2025 Jun 19;45:239-250. doi: 10.1016/j.jpra.2025.06.009. eCollection 2025 Sep.

Abstract

BACKGROUND

Free functional muscle transfers (FFMTs) have emerged as the gold standard for reanimation of chronic facial palsy. However, the various options for neuronal input to power the transferred muscle remain an issue of debate, especially the question whether a single or two different nerves are used. The purpose of this study was to review the available clinical data on single versus dual innervation in FFMTs and compare their outcomes to better understand if dual innervation offers a significant benefit.

METHODS

A systematic review and meta-analysis were performed. Cochrane, EMBASE and PubMed MEDLINE database were searched following PRISMA guidelines 2020. All publications providing original clinical outcome data on dual nerve innervation of FFMTs in human patients were included.

RESULTS

The initial search yielded 451 studies of which 16 met the inclusion criteria for qualitative analysis and 4 for quantitative meta-analysis. A total of 98 patients were analysed, with 53 (51.94 %) women, mean age of 44.5 years in the single-innervation group and 41.2 years in the dual-innervation group, and an average follow-up period of 15 months. Both groups individually showed significant improvements (single innervation 41.1 %, = 0.003, dual-innervation 50.7 %, = 0.017). However, there is insufficient evidence to conclude a statistically significant difference in outcomes between the two methods.

CONCLUSION

Both methods show meaningful improvements post-treatment. The dual innervation patients tended to have longer palsy durations and slightly better but more varied post-treatment improvements with overall no statistically significant difference to the single innervation group.

摘要

背景

游离功能性肌肉移植(FFMTs)已成为慢性面瘫重建的金标准。然而,为移植肌肉提供动力的神经元输入的各种选择仍然是一个有争议的问题,特别是使用一根还是两根不同神经的问题。本研究的目的是回顾FFMTs中单一神经支配与双重神经支配的现有临床数据,并比较它们的结果,以更好地了解双重神经支配是否具有显著优势。

方法

进行了系统评价和荟萃分析。按照2020年PRISMA指南检索了Cochrane、EMBASE和PubMed MEDLINE数据库。纳入所有提供人类患者FFMTs双重神经支配原始临床结果数据的出版物。

结果

初步检索得到451项研究,其中16项符合定性分析的纳入标准,4项符合定量荟萃分析的纳入标准。共分析了98例患者,其中53例(51.94%)为女性,单神经支配组的平均年龄为44.5岁,双神经支配组为41.2岁,平均随访期为15个月。两组各自均显示出显著改善(单神经支配组为41.1%,P = 0.003;双神经支配组为50.7%,P = 0.017)。然而,没有足够的证据得出两种方法在结果上有统计学显著差异的结论。

结论

两种方法在治疗后均显示出有意义的改善。双神经支配的患者往往面瘫持续时间更长,治疗后的改善略好但更具多样性,总体与单神经支配组无统计学显著差异。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/8a28/12343343/78bb73df4df9/gr1.jpg

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