目的 分析面肌痉挛患者显微血管减压术（MVD）后延迟治愈的影响因素，构建并验证列线图风险模型。 方法 选择2022年8月至2024年11月我院收治的108例面肌痉挛患者，所有患者均接受MVD术治疗。术后随访6个月，根据面肌痉挛患者MVD术后是否发生延迟治愈分为观察组与对照组。分析面肌痉挛患者MVD术后发生延迟治愈的影响因素，构建并验证列线图风险模型。 结果 随访后，所有患者均未失访。复发1例、无效1例、部分缓解2例、明显缓解3例、延迟治愈21例、即刻治愈80例。观察组的病史长于对照组（P<0.05），观察组的术中血管压迫程度为重度、术前面肌痉挛严重程度为Ⅳ级、异常面肌反应（AMR）监测为未消失例数占比高于对照组（P<0.05），观察组的面神经根部有压迹例数占比低于对照组（P<0.05）。病史、术中血管压迫程度为重度、术前面肌痉挛严重程度为Ⅳ级、AMR监测为未消失为面肌痉挛患者MVD术后发生延迟治愈的独立危险因素（P<0.05），面神经根部有压迹为面肌痉挛患者MVD术后发生延迟治愈的保护因素（P<0.05）。列线图模型预测面肌痉挛患者MVD术后发生延迟治愈的灵敏度为90.48%，特异度为83.75%，AUC为0.929。 结论 病史长、术中血管压迫程度为重度、术前面肌痉挛严重程度为Ⅳ级、AMR监测为未消失、面神经根部有压迹与面肌痉挛患者MVD术后发生延迟治愈有关，构建列线图风险模型有助于早期识别MVD术后延迟治愈发生风险。
Abstract
Objective To analyze the influencing factors of delayed cure after microvascular decompression (MVD) in patients with hemifacial spasm and to construct and validate a nomogram risk model. Methods A total of 108 patients with hemifacial spasm admitted to our hospital from August 2022 to November 2024 were selected. All patients underwent MVD. They were followed up for 6 months after surgery and divided into the observation group and the control group based on whether delayed cure occurred after MVD. The influencing factors of delayed cure after MVD in patients with hemifacial spasm were analyzed, and a nomogram risk model was constructed and validated. Results After follow-up, no patients were lost to follow-up. There was 1 recurrence, 1 ineffective case, 2 partial remissions, 3 significant remissions, 21 delayed cures, and 80 immediate cures. The observation group had a longer medical history than the control group (P<0.05). The proportion of severe vascular compression during surgery, grade IV hemifacial spasm severity before surgery, and undiminished abnormal muscle response (AMR) monitoring in the observation group was higher than those in the control group (P<0.05). The proportion of patients with nerve root indentation in the observation group was lower than in the control group (P<0.05). Long medical history, severe vascular compression during surgery, grade IV hemifacial spasm severity before surgery, and undiminished AMR monitoring were independent risk factors for delayed cure after MVD in patients with hemifacial spasm (P<0.05). Nerve root indentation was a protective factor for delayed cure after MVD in patients with hemifacial spasm (P<0.05). The nomogram model predicted delayed cure after MVD in patients with hemifacial spasm with a sensitivity of 90.48%, a specificity of 83.75%, and an AUC of 0.929. Conclusions Long medical history, severe vascular compression during surgery, grade IV hemifacial spasm severity before surgery, undiminished AMR monitoring, and nerve root indentation are related to delayed cure after MVD in patients with hemifacial spasm. Constructing a nomogram risk model is helpful for early identification of the risk of delayed cure after MVD.
关键词
面肌痉挛； /
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显微血管减压术； /
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延迟治愈； /
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影响因素； /
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预测模型
Key words
Hemifacial spasm; /
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Microvascular decompression; /
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Delayed cure; /
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Influencing factors /
Prediction model
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基金
安徽省科技厅临床医学研究转化项目（202204295107020053）
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