神经电生理监测在二次改良Foerster-Dandy手术治疗痉挛性斜颈围手术期的应用  

Application of neurophysiological monitoring in the second modified Foerster-Dandy＇s operation for the treatment of spasmodic torticollis during perioperative period

作　　者：刘江[1] 袁越[1] 张黎[1] 赵奎明[1] 徐晓利[1] 刘红举[1] 张哲[1] 杨文强[1] 于炎冰[1] 

机构地区：[1]国家卫生和计划生育委员会中日友好医院神经外科,北京100029

出　　处：《中华神经外科杂志》2015年第5期477-481,共5页Chinese Journal of Neurosurgery

基　　金：国家卫生和计划生育委员会中日友好医院院级课题（2013-QN-27）

摘　　要：目的 评估神经电生理监测在二次改良Foerster-Dandy手术治疗痉挛性斜颈围手术期中的应用.方法 回顾性纳入40例采用二次改良Foerster-Dandy手术治疗的重型痉挛性斜颈患者.术中行脊神经前、后根直接电刺激,根据肌电图（EMG）结果选择神经根切断的比例.术中行体感诱发电位（SEP）监测脊髓传导通路功能的完整性.根据手术前后胸锁乳突肌、斜方肌、头夹肌的EMG结果判定疗效.结果 EMG显示,术后胸锁乳突肌、斜方肌、头夹肌的转折数、波幅均较术前的比值下降（P＜0.01）,胸锁乳突肌下降程度更明显;胸锁乳突肌的转折数与波幅的比值较术前下降（P＜0.01）,斜方肌、头夹肌该比值变化不明显.根据术中监测结果,双侧副神经切断的比例为100％,C1前根为80％ ～ 90％,C2前根60％ ～ 75％,C2后根10％～15％,C3前根45％～60％,C3后根50％～70％.2例患者术中SEP波幅及潜伏期较预警基准电位下降,经调整手术操作方式或停止操作后恢复,术后均无脊髓功能损害表现.随访0.5 ～2.5年,随访期间缓解率为92.5％ （37/40）,3例痉挛状态不同程度复发.结论 手术前后同一痉挛责任肌肉EMG相关参数的差异可客观地评估手术疗效;术中电生理监测量化了神经切断的比例,可避免神经损伤;术中SEP监测能有效地减少高位颈髓损伤的可能.Objective To evaluate the application of neurophysiological monitoring in the second modified Foerster-Dandy＇s operation for the treatment of spasmodic torticollis during perioperative period.Methods Forty patients with severe spasmodic torticollis treated with the second modified Foerster-Dandy＇s operation were enrolled retrospectively.Direct electrical stimulation of anterior and posterior roots of spinal nerves was performed during the operation.The proportion of rhizotomy was selected according to the results of electromyography （EMG）.Intraoperative somatosensory evoked potential （SEP） was used to monitor the integrity of spinal transduction pathway function.The efficacy was determined according to the EMG results of sternocleidomastoid,trapezius,and splenius capitis before and after surgery.Results EMG showed that the turning numbers and amplitudes of sternocleidomastoid,trapezius,and splenius capitis after surgery were decreased compared with before surgery （P 〈 0.01）.The decreased degree of sternocleidomastoid was more significantly;the ratios of the turning number and amplitude of sternocleidomastoid were decreased （P 〈 0.01）,whereas the ratios of trapezius and splenius capitis did not change obviously.According to the results of intraoperative monitoring,the proportion of bilateral accessory neurectomy was 100%,anterior roots of C1 was 80%-90%,anterior roots of C2 was 60%-75%,posterior roots of C2 was 10%-15%,anterior roots of C3 was 45%-60%,and posterior roots of C3 was 50%-70%.The intraoporative SEP amplitude and latency in 2 patients were decreased compared with the warning reference potential.They recovered after adjusting surgical operation mode or stopping operation.No postoperative spinal cord function injury was observed.The patients were followed up for 0.5-2.5 years.The remission rate was 92.5% （37/40） during follow-up period.The spasticity recurred in varying degrees in 3 cases.Condlusions The differences of EMG related parameters of the same spastic guilty muscle b

关 键 词：痉挛性斜颈 监测 生理学 肌电描记术 Foerster-Dandy手术 

分 类 号：R687.3[医药卫生—骨科学]