脊髓栓系综合征患儿盆底神经电生理检测特点和临床意义  

Electrophysiological study of pelvic floor musculature, of tethered cord syndrome

作　　者：张丽[1] 李金良[1] 孙小兵[1] 李艳华[1] 陈雨历[1] 

机构地区：[1]山东大学第二医院小儿外科,济南250033

出　　处：《中华小儿外科杂志》2012年第5期370-373,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的利用神经电生理检测技术分析脊髓栓系综合征（tetheredcordsyndrome，TCS）患儿盆底神经和肌肉功能改变的特点，评价TCS患儿盆底神经肌肉损伤的程度。方法2008年5月至2010年12月对88例TCS患儿组和26例正常患儿行双侧肛提肌、耻骨直肠肌和肛门外括约肌肌电图检查，以及阴部神经运动传导和阴部神经体感诱发电位（PN-SSEP）检查。结果正常对照组患儿肛提肌、肛门外括约肌和耻骨直肠肌在静息状态时均可见持续收缩动作电位，大力收缩动作电位密集，呈干扰相。患儿组盆底肌肌电图（pelvicfloormuscleselectromyographic，PFM-EMG）表现为不同程度的神经源性损害，甚至呈现完全失神经支配，肛提肌较肛门外括约肌病变严重。患儿组阴部神经运动传导波幅降低，潜伏期延长，其中15例患儿出现双侧不对称。阴部神经体感诱发电位潜伏期延长，甚至波形消失。结论盆底神经电生理学检测对了解TCS盆底神经肌肉损害程度，评价大小便功能，估计预后具有重要意义。Objective We aim to analyze the electrophysiologieal characteristics of pelvic floor musculature of the patients with tethered cord syndrome（TCS）, and to evaluate the extent of pelvic floor neuromuscular injury. Methods 88 Patients with tethered cord syndrome and 26 normal children had electromyography of levator ani, puborectalis and external anal sphincter performed. Pudendalmo- tor nerve conduction, as well as pudendal nerve somatosensory evoked potential study（PN-SSEP） were carried out from May, 2008 to December, 2010. Results Levator ani, external anal sphincter and pu- borectalis all had tonic activity in normal children at rest. During maximum voluntary contraction, ac- tion potential was seenas an increase of the firing frequency of these motor units, and recruitment of motor units was of interference pattern（IP）. In patients suffering from TCS, PFM EMG indicated dif- ferent degrees of neurogenic damage, even： to the degree of total denervation. The amplitude of puden- dal nerve motor conduction decreased and latency prolonged in TCS group, together with delayed cortical potential latency（P41）, and increased stimulation threshold. Conclusions The electrophysiological study of pelvic floor muscles could help us understand the degree of neuromuscular damage in pa- tients with TCS,and further evaluate urinary and fecal function and prognosis.

关 键 词：脊髓栓系综合征 肌电图 神经传导 诱发电位 

分 类 号：R748[医药卫生—神经病学与精神病学]