Taira T, Kawamura H, Tanikawa T, Kawabatake H, Iseki H, Imamura T, Atsuchi M, Kawashima A, Takakura K
Department of Neurosurgery, Tokyo Women's Medical College.
No Shinkei Geka. 1997 Oct;25(10):927-32.
The authors evaluated the results of selective peripheral denervation (SPD) of posterior rami of the cervical spinal nerves and/or the accessory nerve for spasmodic torticollis. Five patients underwent seven operations in total and the results were evaluated with the modified Tsui's score which was used in the clinical trial of botulinum toxin (BTX) for torticollis in Japan. The preoperative score was 10.8 +/- 2.2 (mean +/- S.D.) and the postoperative score was 1.4 +/- 1.7. The score changes indicated the effects of the operation as "excellent" in four cases and "good" in one case. These results indicate that SPD is superior to BTX in terms of control of symptoms in spasmodic torticollis. After the initial operation, however, two patients showed the so-called "mole-hitting game phenomenon" in which normal muscles develop abnormal contraction after denervation of abnormal muscles. This forced us to perform the second operations. Although this phenomenon was first described in botulinum toxin treatment, this is probably the first report in surgically denervated cases.
作者评估了颈脊神经后支和/或副神经选择性周围神经切断术（SPD）治疗痉挛性斜颈的效果。5例患者共接受了7次手术，并采用在日本用于肉毒杆菌毒素（BTX）治疗斜颈的临床试验中的改良崔氏评分来评估结果。术前评分为10.8±2.2（均值±标准差），术后评分为1.4±1.7。评分变化显示手术效果为4例“优”，1例“良”。这些结果表明，在控制痉挛性斜颈症状方面，SPD优于BTX。然而，在初次手术后，2例患者出现了所谓的“打鼹鼠游戏现象”，即在异常肌肉去神经支配后，正常肌肉出现异常收缩。这迫使我们进行了第二次手术。尽管这种现象最早在肉毒杆菌毒素治疗中被描述，但这可能是手术去神经支配病例中的首次报告。
