多模式电生理监测在选择性脊神经后根切断术中的临床应用探讨  

Clinical application of multi-mode electrophysiological monitoring in selective posterior rhizotomy

作　　者：叶红[1] 陈黎敏[1] 顾海燕[1] 徐冠华[2] 葛建林[3] 俞兴[4] 保国锋[2] YE Hong;CHEN Limin;GU Haiyan(Operating Room,the Second Affiliated Hospital of Nantong University,Nantong(226001),Jiangsu China)

机构地区：[1]南通大学第二附属医院手术室,江苏南通226001 [2]南通大学第二附属医院脊柱外科,江苏南通226001 [3]南通大学第二附属医院麻醉科,江苏南通226001 [4]北京中医药大学东直门医院骨科

出　　处：《癫痫与神经电生理学杂志》2020年第6期321-327,共7页Journal of Epileptology and Electroneurophysiology(China)

基　　金：南通市社会民生科技计划面上项目(NO:MSZ18249);江苏省“六个一工程”项目资助(NO:LGY2017038);江苏省卫计委“科技强卫工程”青年医学人才(NO:QNRC2016410)。

摘　　要：目的:探讨多模式电生理监测在选择性脊神经后根切断术(SPR)中的指导价值。方法:回顾性分析2016年12月至2018年11月南通大学第二附属医院收治的行SPR的痉挛型脑性瘫痪患儿30例,14例患儿采用单纯刺激肌电图法并且观察双腿摆动的幅度,小束之间进行比较,选择肌电图波幅大的进行后根小束切断:16例患儿术中采用体感诱发电位、运动诱发电位、球海绵体括约肌反射、自由肌电图和触发肌电图多模式监测。观察两组手术疗效及并发症发生率。结果:多模式电生理组下肢感觉异常1例,术后随访1个月恢复正常;术后肌力较术前下降1例,术后4个月恢复正常。下肢痉挛缓解率为87%。单纯刺激肌电组下肢感觉异常2例,术后随访2个月恢复正常;术后肌力较术前下降2例,术后5个月恢复正常;有1例患儿出现腹胀及肠绞痛,术后4d逐渐好转;2例患儿出现一过性尿潴留。下肢痉挛缓解率为69%。结论:SPR中,应用多模式电生理监测综合评估相对单纯刺激肌电监测,能够更加精确地判断需切断的神经束,预警不必要的神经损伤,从而提高手术疗效,减少术后并发症的发生率,提高手术安全性。Objective:To explore the guiding value of multi-mode electrophysiological monitoring in the selective posterior rhizotomy(SPR).Methods 30 children with spastic cerebral palsy(CP)trea­ted with SPR were retrospectively analyzed from December 2016 to November 2018.14 cases were treated with simple triggered-EMG and the swing amplitude of legs was observed.Comparison be­tween small bundles and the posterior root bundles were made according to larger amplitude of trig-gered-EMG.16 cases were treated by multi-mode monitoring including somatosensory evoked potential(SEP),motor evoked potential(MEP)and cavernous sphincter reflex,free EMG and trigger-EMG.The curative effect and complication rate of the two groups were observed.Results In multi-mode elec­trophysiology group,I case with sensory abnormalities in the lower limbs returned to normal after one month’s follow-up.The postoperative muscle strength decreased I case before surgery and returned to normal 4 months after surgery.The lower extremity spasm relief rate was 87%.In Triggered-EMG group,2 cases of postoperative lower limbs felt abnormal,but turned to normal after one months fol­low-up;postoperative muscle strength decreased in 2 cases before surgery,but returned to normal two months after surgery;I case with abdominal distension and colic was gradually recovered four days af­ter surgery;two cases developed transient urinary retention.The rate of limb spasm relief was 69.2%.Conclusion In SPR the multi-mode monitoring and comprehensive evaluation can more accu­rately judge the need to cut off the nerve bundle and avoid unnecessary nerve injury,so as to improve the surgical effect,reduce the incidence of postoperative complications and maintain the safety of oper­ation.

关 键 词：选择性脊神经后根切断术(SPR) 电生理监测 脑性瘫痪 痉挛 

分 类 号：R741.044[医药卫生—神经病学与精神病学] R651[医药卫生—临床医学]