术中神经电生理监测对第5腰椎水平选择性脊神经后根切断术的影响研究

Effect of intraoperative neurophysiological monitoring on lumbar 5 selective posterior rhizotomy in patients with cerebral palsy

目的分析术中神经电生理监测对第5腰椎节段水平选择性脊神经后根切断术的影响,为探讨术中神经电生理监测对多节段选择性脊神经后根切断术的意义提供参考依据。方法回顾性分析2020年11月至2022年3月清华大学玉泉医院收治的40例行第5腰椎选择性脊神经后根切断术的脑瘫患儿临床资料,依据术中是否进行神经电生理监测,分为未监测组(13例)和监测组(27例)。比较两组患儿第5腰椎脊神经后根切断比例、术前肌张力和术后肌张力改善情况。结果未监测组左侧脊神经后根切断比例为(57±11)%,监测组左侧脊神经后根切断比例为(46±10)%,差异有统计学意义(P<0.05);未监测组右侧脊神经后根切断比例为(53±2)%,监测组右侧脊神经后根切断比例为(39±3)%,差异有统计学意义(P<0.05)。监测组和未监测组术前经表面肌电图测得的肌张力差异无统计学意义(P>0.05);两组手术后双侧腘绳肌、小腿三头肌肌张力的改善情况差异无统计学意义(P>0.05)。结论对于脑瘫这类中枢神经损伤引起肢体肌张力增高的患儿,选择性脊神经后根切断术可有效改善症状,术中进行神经电生理监测,可以减少脊神经后根切断比例,同时不影响肌张力的改善,因而可望减少术后并发症和不必要的神经损伤。

Objective To explore the effect of intraoperative electrophysiological monitoring on transection proportion of lumbar 5 spinal nerve posterior root,examine the effect on muscle tonus of hamstring,and triceps muscle groups and provide reliable rationales for the significance of intraoperative electrophysiological monitoring on multi-level selective spinal nerve posterior rhizotomy.Methods From November 2020 to March 2022,clinical data was retrospectively reviewed for 40 cerebral palsy patients undergoing selective posterior rhizotomy of lumbar 5 segment.According to the absence and presence of intraoperative neurophysiological monitoring,they were divided into two groups of non-monitoring(n=13)and monitoring(n=27).Ratio of lumbar 5 spinal nerve posterior root transection,preoperative muscle tension and improvement rate of muscle tension were compared between two groups.Results The proportion of left spinal nerve posterior root transection in non-monitoring group was(57±11)%and(46±10)%in monitoring group.The difference had statistical significance(P<0.05).The proportion of right posterior spinal nerve root transection was(53±2)%in non-monitoring group and(39±3)%in monitoring group.The difference was statistically significant(P<0.05).No significant inter-group difference existed in muscle tension on preoperative surface electromyography(P>0.05).No significant inter-group difference existed in improvement rate of bilateral hamstring and triceps muscle tension(P>0.05).Conclusion Intraoperative neurophysiological monitoring of children undergoing selective posterior rhizotomy may reduce the proportion of rhizotomy without affecting the improvement rate of muscle tone.It minimizes postoperative complications and unnecessary nerve injuries.