周围性面神经麻痹的发病机制与脉冲射频治疗进展

Pathogenesis of Peripheral Facial Nerve Palsy and Advances in Pulsed Radiofrequency Therapy

摘要: 周围性面神经麻痹(facial nerve palsy, FNP)是临床最常见的单发性颅神经疾病，年发病率为11.5~53.3/10万，各年龄段均可发病。约30%患者遗留眼睑闭合不全、面肌痉挛等后遗症，严重影响生活质量。传统药物及物理康复对重度FNP疗效有限，手术干预创伤大、恢复周期长。脉冲射频(pulsed radiofrequency, PRF)作为微创神经调控技术，通过可控电磁场调节神经功能，在保留神经结构完整性的同时发挥神经激活、改善局部血供、抑制炎症及促进神经再生作用，为难治性FNP提供新选择。本文系统综述FNP核心发病机制，重点从病毒感染与炎症反应、缺血与微循环障碍、面神经管解剖易损性及氧化应激四个方面阐述。总结传统治疗局限，聚焦PRF神经调控技术，详细论述其作用机制、治疗时间窗口、疗效评估及适应证选择。分析当前研究局限，包括高质量证据匮乏、治疗参数不统一、机制未完全阐明等问题，并对未来研究方向进行展望。

Abstract: Peripheral facial nerve palsy (FNP) is the most common cranial mononeuropathy, with an annual incidence of 11.5 to 53.3 per 100,000 population. Although most patients achieve satisfactory recovery with standard treatment, approximately 30% develop persistent sequelae, including incomplete eye closure and facial synkinesis, significantly impairing quality of life. Conventional pharmacological therapies and physical rehabilitation show limited efficacy in severe FNP cases, while surgical interventions are invasive and require prolonged recovery. Pulsed radiofrequency (PRF) is a minimally invasive neuromodulation technique that regulates neural function through controlled electromagnetic fields without causing thermal damage. It has emerged as a promising therapeutic alternative for refractory FNP by exerting multiple effects, including neuronal activation, enhanced local blood supply, anti-inflammatory action, and promotion of nerve regeneration. This review systematically examines the core pathophysiological mechanisms of FNP, focusing on four key aspects: viral infection and inflammatory response, ischemia and microcirculatory disturbance, anatomical vulnerability of the facial nerve canal, and oxidative stress. We summarize the limitations of conventional therapies and provide a detailed discussion of PRF neuromodulation, including its mechanisms of action, optimal treatment windows, efficacy assessment methods, and indications. Current research limitations, particularly the scarcity of high-quality evidence, heterogeneous treatment parameters, and incompletely elucidated mechanisms of action, are critically analyzed, and future research directions are proposed. This review aims to provide a theoretical basis for the individualized and precise management of FNP and the standardized clinical application of PRF technology.