Gu X M, Zhou S X, Liu B L
Stomatological College Fourth Military Medical University, Xi'an.
Zhonghua Kou Qiang Yi Xue Za Zhi. 1994 Nov;29(6):323-5, 383.
In this prospective study, patients were randomly divided into 3 groups according to 3 different operation procedures used to correct facial palsy with microneurovascular anastomosed muscle transplantation: In group 1, 9 patients accepted cross face transplantation of segmental latissimus dorsi muscle flap with super-long neurovascular pedicle, through upper labial tunnel, anastomosed in normal face (one stage method); In group 2, 7 patients accepted cross face nerve graft and secondary free muscle transplantation by neurovascular anastomoses in paralyzed face (two stage method); In group 3, 5 patients, free muscle transplantation by microneurovascular anastomosis in paralyzed face. The appreciation for the results was carried out in 16 patients who had been followed-up more than 1 year. In terms of functional recovery, the success rate ranged in excellent and good reached 93.8%. There were not significant differences among groups. The patients of less than 40-year-old got better results and the correlation between operative effects and both cause and course of disease could not be found. It was considered that the nerve regeneration speed and quality in one stage method were better than sural nerve graft with small saphenous vein anastomosis, because physiological blood supply was kept well along the nerve pedicle and regenerating nerve fibers need not pass through two suture sites. Patients satisfied the results after the swelling was gone because one stage method had the advantages of face lift and selective neurotomy at the same time. The course of treatment was shortened significantly as well.
在这项前瞻性研究中，根据用于通过显微神经血管吻合肌肉移植矫正面瘫的3种不同手术方法，将患者随机分为3组：第1组，9例患者接受带超长神经血管蒂的背阔肌肌瓣跨面神经移植，经上唇隧道，吻合于正常面部（一期法）；第2组，7例患者接受跨面神经移植及二期在面瘫侧行神经血管吻合的游离肌肉移植（二期法）；第3组，5例患者在面瘫侧行显微神经血管吻合游离肌肉移植。对16例随访超过1年的患者进行了结果评估。在功能恢复方面，优良率达93.8%。组间差异无统计学意义。年龄小于40岁的患者效果较好，未发现手术效果与病因及病程之间存在相关性。认为一期法中神经再生速度和质量优于吻合小隐静脉的腓肠神经移植，因为沿神经蒂保持了良好的生理性血供，再生神经纤维无需通过两个缝合部位。一期法同时具有面部提升和选择性神经切断的优点，肿胀消退后患者对结果满意。治疗疗程也显著缩短。
