术中肌电图监测在圆锥部选择性脊神经后根切术中的应用

Application of Electromyography Monitor on Medullary Conus Level During Selective Posterior Rhizotomy

目的:探讨术中肌电图监测在圆锥部选择性脊神经后根切断术(selective posterior rhizotomy,SPR)治疗痉挛型脑瘫的临床意义。方法:对70例痉挛型脑瘫患儿行圆锥部SPR术,术中将L1～S1(除L4)各后根均匀分为2～5个神经束,然后行由低到高的电流刺激,确定每束阈值,根据阈值确定切除部分的比例,并在手术全程对下肢多组肌肉及肛门括约肌收缩情况进行肌电图监测,以防损伤脊髓运动根和支配括约肌的感觉根。结果:本组70例痉挛型脑瘫患者中,术后4周、术后6个月肌张力较术前比较均有统计学意义(P<0.05);术后6个月步行功能与术前步行功能比较有统计学意义(P<0.05)。踝阵挛消失率91%(59/65),髌阵挛消失率96%(22/23),肌力均保持在术前以上水平,所有患者术后无大小便功能障碍。结论:术中电刺激是指导和监测圆锥部脊神经后根选择性切断的有效方法,对提高手术疗效,保护括约肌功能具有重要意义。

Objective：The purpose of this study is to evaluate the effect electromyography（EMG） monitor during selective posterior rhizotomy for spastic cerebral palsy.Methods：There were70 patients with spastic cerebral palsy received selective posterior rhizotomy（SPR）,Every root from L1 to S1（except L4）,was separated into two to five rootlets.Then from low to high current stimulation to determine thresholds for each beam,according to the threshold values determine the Proportion of resection.Each rootlet was tested by electrical stimulation and the muscle responses of lower limbs and anal sphincter were observed visually and registered by EMG in all operative process.Prevent injury spinal cord motor and control the sphincter sensory root.Results：In this set of 70 patients with spastic cerebral palsy,after 4 weeks,after 6 months of muscular tension than earlier were statistically significant.（P〈0.05）;The walking ability have significant statistical difference between six months after the operation and preoperative（P〈0.05）;91% of the ankle clonus were corrected completely,96% of the Patellar generalized tonic-clonic were corrected completely,muscle strength is maintained above the level prior to the surgery,and all 0cases without dysfunction of urination and defecation of Post-operation.Conclusions：Intraoperative electrical stimulation is to guide and monitor effective method of selective cutting of tapered dorsal root,E1ectmmyogmphy monitoring during SPR is crucial to enhance the improvements and protect the sphincter function.