改良舌下神经-面神经转位术舌功能再评价：一项比较性队列研究
Revaluation of the tongue function of the modified hypoglossal-to-facial transfer: a comparative cohort study.
文献信息
| PMID | 42871405 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Ying Zhang |
| 作者单位 | Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China. |
| 期刊 | Frontiers in neurology |
| SCI 分区 | Q2 |
| IF | 3.5 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景与目的： 传统的端对端舌下神经-面神经吻合术（HFA）是治疗未愈严重面瘫的常见手术方式，但与舌功能障碍相关。我们开发了一种改良舌下神经-面神经吻合术（MHFA），额外将切断的舌下神经与舌下神经降支吻合，旨在挽救舌功能。
方法： 我们回顾性收集了本中心2020年1月至2022年12月期间的45例MHFA病例。将MHFA与本中心早期27例HFA病例进行比较分析。随访期间使用舌残疾指数评估舌功能。
结果： HFA组（n=27）与MHFA组（n=45）的基线特征具有可比性（均p>0.05）。MHFA手术时间更长（198.27 vs. 157.78分钟，p<0.001）。截至末次随访，MHFA显示出更优的结果：舌偏斜角度更小（13.38°±9.56° vs. 23.86°±10.52°，平均差10.47°[95%CI 5.65-15.29]，p<0.001），严重偏斜（>30°）发生率更低（8.9% vs. 37.0%，p=0.003），舌相关并发症减少（24.4% vs. 66.7%，p<0.001）。具体而言，MHFA的吞咽（11.1% vs. 37.0%，p=0.009）和构音缺陷（13.3% vs. 44.4%，p=0.003）显著更少。MHFA的TDI评分明显更低（1.63±0.53 vs. 2.23±0.50，平均差0.60[0.34-0.85]，p<0.001），尤其是在吞咽、构音和心理子领域（均p<0.05）。舌偏斜与TDI评分之间存在强相关性（r=0.890，p<0.001）。面神经恢复在组间无差异（HB评分改善：2.40±0.69 vs. 2.33±0.73，p=0.699）。
结论： MHFA在减少舌部并发症方面似乎有前景，但其相对于HFA的临床相关优势需要使用标准化结局进行前瞻性验证。
英文摘要
BACKGROUND AND OBJECTIVES: Traditional end-to-end hypoglossal-to-facial anastomosis (HFA) was a common surgical procedure for uncured severe facial palsy, however, was related to tongue dysfunction. We developed a modified hypoglossal-to-facial anastomosis (MHFA) procedure with the additional process of the anastomosis of the transected hypoglossal nerve and the ramus descendens hypoglossi, aiming to salvage the tongue function.
METHODS: We retrospectively collected 45 cases of MHFA in our center from January 2020 to December 2022. A comparative analysis was conducted from MHFA and 27 cases of HFA in the early stage at our center. The tongue disability index was used to evaluate the tongue function during the follow-up.
RESULTS: Baseline characteristics were comparable between HFA (n = 27) and MHFA (n = 45) groups (all p > 0.05). MHFA demonstrated longer operative time (198.27 vs. 157.78 min, p < 0.001). Up to the last follow-up, MHFA showed superior outcomes: smaller tongue deviation angle (13.38° ± 9.56° vs. 23.86° ± 10.52°, mean difference 10.47°[95%CI 5.65-15.29], p < 0.001), lower incidence of severe deviation (>30°: 8.9% vs. 37.0%, p = 0.003), and reduced tongue-related complications (24.4% vs. 66.7%, p < 0.001). Specifically, MHFA had significantly fewer swallowing (11.1% vs. 37.0%, p = 0.009) and articulation defects (13.3% vs. 44.4%, p = 0.003). TDI scores were markedly lower in MHFA (1.63 ± 0.53 vs. 2.23 ± 0.50, mean difference 0.60 [0.34-0.85], p < 0.001), particularly in swallowing, articulation, and psychological subdomains (all p < 0.05). Strong correlation existed between tongue deviation and TDI scores (r = 0.890, p < 0.001). Facial nerve recovery showed no intergroup difference (HB score improvement: 2.40 ± 0.69 vs. 2.33 ± 0.73, p = 0.699).
CONCLUSION: MHFA appears promising for reducing tongue morbidity, but its clinically relevant advantage over HFA requires prospective validation using standardized outcomes.