患人类开放性脊柱裂的新生儿的运动功能丧失  

Neonatal loss of motor function in human spina bifida aperta

作　　者：Sival D.A. Van Weerden T.W. Vles J.S.H. 肖莉 

机构地区：[1]Pediatric NeurologyDepartment of Pediatrics,University Hospital Groningen,PO Box 30.001,9713 GZ Groningen,Netherlands

出　　处：《世界核心医学期刊文摘（儿科学分册）》2005年第1期58-59,共2页

摘　　要：目的:患有开放性脊柱裂(SBA)的新生儿,其由马尾至脊膜脊髓膨出脊髓节段控制的腿部的运动会暂时性存在。这一对患SBA新生儿的研究的目的是确定腿部运动的存在是否表明了神经支配功能的完整性,以及腿部运动的消失是否是上运动神经元(从颅脑起始到脊膜脊髓膨出处的轴索)和(或)下运动神经元(从马尾到脊膜脊髓膨出间)的功能障碍的结果。方法:研究出生后1 d(n=8)和7 d(n=10)的新生儿的腿部运动。Objective. In neonates with spina bifida aperta (SBA), leg movements innervated by spinal segments located caudal to the meningomyelocele are transiently present. This study in neonates with SBA aimed to determine whether the presence of leg movements indicates functional integrity of neuronal innervation and whether these leg movements disappear as a result of dysfunction of upper motor neurons (axons originating cranial to the meningomyelocele) and/ or of lower motor neurons (located caudal to the meningomyelocele). Methods. Leg movements were investigated in neonates with SBA at postnatal day 1 (n = 18) and day 7 (n = 10). Upper and lower motor neuron dysfunction was assessed by neurologic examination (n = 18; disinhibition or inhibition of reflexes, respectively) and by electromyo-graphy (n = 12; absence or presence of denervation potentials, respectively) . Results. Movements, related to spinal segments caudal to the meningomyelocele, were present in all neonates at postnatal day 1. At day 1, leg movements were associated with signs of both upper (10 of 18) and lower (17 of 18) motor neuron dysfunction caudal to the meningomyelocele. In 7 of 10 neonates restudied after the first postnatal week, leg movements had disappeared. The absence of leg movements coincided with loss of relevant reflexes, which had been present at day 1, indicating progression of lowermotor neuron dysfunction. Conclusions. We conclude that the presence of neonatal leg movements does not indicate integrity of functional lower motor neuron innervation by spinal segments caudal to the meningomyelocele. Present observations could explain why fetal surgery at the level of the meningomyelocele does not prevent loss of leg movements.

关 键 词：脊膜脊髓膨出 上运动神经元 脊柱裂 脊髓节段 出生后 轴索 脊柱节段 神经支配 胎儿外科 检查法 

分 类 号：R722.1[医药卫生—儿科]