目的 周围性舌下神经麻痹的临床诊治率较低,相当一部分患者未能得到及时而正确的康复治疗。本文旨在报道颈动脉内膜剥脱术致周围性舌下神经麻痹的综合康复治疗方法及临床疗效。方法2016年3月1日,天津医科大学总医院康复医学科收入1例颈动脉内膜剥脱术致周围性舌下神经麻痹患者,对该患者进行包括舌肌运动训练、神经肌肉电刺激疗法和远红外线治疗在内的为期15 d的综合康复治疗及口服神经营养药物治疗。回顾性分析诊治过程,并对相关文献进行复习。结果接受综合康复治疗15 d后,舌肌较治疗前灵活,构音较治疗前清晰,吞咽时对食团的控制能力和搅拌能力均得到改善;伸舌虽然仍略向右偏斜,但舌正中沟与正中线的夹角较治疗前减少17.5°;右侧舌体表面皱褶减少,舌体饱满红润;舌尖向上可触及上嘴唇;向左舔嘴角时费力程度减轻;向右伸舌时颈部肌肉张力明显降低;向口腔内部卷曲舌尖可触及软腭边缘。康复治疗效果令人满意。结论周围性舌下神经麻痹的康复治疗方法鲜见报道。在口服神经营养药物的基础上,同时应用舌肌运动训练、神经肌肉电刺激疗法和远红外线治疗在内的康复治疗方法,可以有效地改善患者的舌肌运动功能和舌肌萎缩程度,成为改善周围性舌下神经麻痹的安全而有效的康复治疗方法。
Abstract
Objective: The diagnosis and treatment rates of peripheral hypoglossal nerve palsy are low, and a considerable number of patients fail to get timely and appropriate rehabilitation treatment. The purpose of this paper is to report the comprehensive rehabilitation therapy of peripheral hypoglossal nerve paralysis caused by carotid endarterectomy and its effectiveness.Methods: One case of peripheral hypoglossal nerve palsy caused by carotid endarterectomy was admitted in Department of Rehabilitation Medicine, Tianjin Medical University General Hospital in March 1st, 2016. This patient received oral administration of neurotrophic drugs and were treated with comprehensive rehabilitation treatment including tongue muscle training, neuromuscular electrical stimulation therapy and far infrared therapy for 15 days. Retrospective analysis of the diagnosis and treatment process was performed, and the relevant literature was reviewed.Results: After comprehensive rehabilitation treatment for 15 days, the muscle of the tongue was more flexible, and the articulation was more clear, also showing an improved ability to control and mix the food bolus; while the tongue was still slightly right-skewed, but the deflection angle of tongue median groove was decreased by 17.5 degrees; the wrinkles on the right side surface of the tongue were reduced, and the tongue looked plump and ruddy; the tip of the tongue could touch the upper lip, with less difficulty in licking the left side of the mouth; the tension of the neck muscles was decreased significantly when stuck out the tongue to the right; when curled the tip of the tongue inside the mouth, it could touch the edge of the soft palate. The therapeutic effect of rehabilitation was satisfying.Conclusion: The treatment of peripheral hypoglossal nerve paralysis has been rarely reported. On the basis of oral neurotrophic drugs, the application of rehabilitation therapy including tongue muscle training, neuromuscular electrical stimulation therapy and far infrared therapy, can effectively improve the patient’s tongue muscle function and tongue muscle atrophy, which has become a safe and effective rehabilitation therapy to relieve the peripheral hypoglossal nerve palsy.
关键词
舌下神经损伤 /
周围性舌下神经麻痹 /
颈动脉内膜剥脱术 /
康复 /
治疗结果
Key words
Hypoglossal nerve injuries /
Peripheral hypoglossal nerve paralysis /
Carotid endarterectomy /
Rehabilitation /
Treatment outcome
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参考文献
[1] KERNAN W N, OVBIAGELE B, BLACK H R, et al.Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2011, 42(1):227-276.
[2] ROTHWELL P M, ELIASZIW M, GUTNIKOV S A, et al.Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis[J]. Lancet, 2003, 361(9352):107-116.
[3] SAJID M S, VIJAYNAGAR B, SINGH P, et al.Literature review of cranial nerve injuries during carotid endarterectomy[J]. Acta Chirurgica Belgica, 2007, 107(1):25-28.
[4] FERGUSON G G, ELIASZIW M, BARR H W K, et al. The North American symptomatic carotid endarterectomy trial surgical results in 1415 patients[J]. Stroke, 1999, 30(9):1751-1758.
[5] FOKKEMA M, BORST G J D, NOLAN B W,et al. Clinical Relevance of Cranial Nerve Injury following Carotid Endarterectomy Clinical relevance of cranial nerve injury following carotid endarterectomy[J]. Eur J Vasc Endovasc Surg, 2014, 47(1):2-7.
[6] FORTES F S, DA SILVA E S, SENNES L U. Mandibular subluxation for distal cervical exposure of the internal carotid artery[J]. Laryngoscope, 2007, 117(5):890-893.
[7] 王荣. 赵润琛三点两俞一板法治疗颈源性舌下神经麻痹的经验[J]. 北京中医药, 2012, 31(5):343-344.
[8] 于洋, 訾传伦, 高维滨. 夹脊电针治疗颈性舌下神经麻痹4例[J]. 针灸临床杂志, 2008, 24(5):22.
[9] 李文, 陈哲, 雷晓旭, 等. 颈深神经或副神经整复舌下神经临床效果初探[J]. 临床耳鼻咽喉头颈外科杂志, 2011, 25(3):116-118.
[10] EVGENIEVA E, SCHWEIGERT P, GUNTINAS-LICHIUS O, et al.Manual stimulation of the suprahyoid-sublingual region diminishes polynnervation of the motor endplates and improves recovery of function after hypoglossal nerve injury in rats[J]. Neurorehabil Neural Repair, 2008, 22(6):754-768.
[11] MAROULIS J, KARKANEVATOS A, PAPAKOSTAS K, et al.Cranial nerve dysfunction following carotid endarterectomy[J]. Int Angiol, 2000, 19(3):237-241.
[12] BALLOTTA E, DA GIAU G, RENON L, et al.Cranial and cervical nerve injuries after carotid endarterectomy: a prospective study[J]. Surgery, 1999, 125(1):85-91.
[13] CARLSON B M.The biology of long-term denervated skeletal muscle[J]. Eur J Transl Myol, 2014, 24(1):3293.
[14] Booth F W.Effect of limb immobilization on skeletal muscle[J]. J Appl Physiol Respir Environ Exerc Physiol, 1982, 52(5):1113-1118.
[15] MIYAZAKI M, HITOMI Y, KIZAKI T, et al.Contribution of the calcineurin signaling pathway to overload-induced skeletal muscle fiber-type transition[J]. J Physiol Pharmacol, 2004, 55(4):751-764.
[16] GAJDOSIK R L.Passive extensibility of skeletal muscle: review of the literature with clinical implications[J]. Clin Biomech, 2001, 16(2):87-101.
[17] AHLBORN P, SCHACHNER M, IRINTCHEV A.One hour electrical stimulation accelerates functional recovery after femoral nerve repair[J]. Exp Neurol, 2007, 208(1):137-144.
[18] CONNOR N P, RUSSELL J A, JACKSON M A, et al.Tongue muscle plasticity following hypoglossal nerve stimulation in aged rats[J]. Muscle Nerve, 2013, 47(2):230-240.
[19] TOYOKAWA H, MATSUI Y, UHARA J, et al.Promotive effects of far-infrared ray on full-thickness skin wound healing in rats[J]. Exp Biol Med, 2003, 228(6):724-729.
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