周围神经选切治疗痉挛性脑瘫中电刺激阈值的意义探讨

The clinical significance of the threshold of rootlet in treatment of spastic cerebral palsy by selective peripheral neurotomy

目的 :探讨在周围神经选切治疗痉挛性脑瘫中阈值的意义。方法 :41例痉挛性脑瘫 ,16例SPR和 8例SAR术中电刺激脊神经前后根神经小束 ,2 8例经皮刺激坐骨神经 ,观察相应肌肉运动诱发反应 ,2 5例取周围神经标本 40个 ,进行透射电镜观察。结果 :电刺激神经小束或坐骨神经诱发的肌肉收缩反应或M波幅 ,存在着最大、最小现象。当达到最大后 ,保持稳定 ,不再随刺激强度增大而增加。周围神经呈原发性脱髓鞘病变 ,有髓纤维病变明显于无髓纤维 ,粗纤维重于细纤维。结论 :在周围神经选切治疗痉挛性脑瘫中 ,阈值作为判断所切神经小束中能够基本正常发挥有髓纤维传导功能的纤维含量 ,存在着一定的可行性。

Objective:To investigate the clinical sig ni ficance of threshold of rootlet in treatment of spastic cerebral palsy by selec tive peripheral neurotomy. Methods:Of 41 patients , 16 underwent selective posterior rhizotomy and 8 unde rwent selective anterior rhizotomy. Those nerve rootlets were stimulated by a si ngle stimulus, the muscular responses in the segmental distribution of the rootl et were observed.The features of motor evoked responses in gastrocnemius muscle were observed in 28 patients by percutaneous sciatic nerve stimulation. 40 per ipheral nerve specimens of 25 patients with spastic cerebral palsy were observed under electron microscope.Results:Those evoked resp onse, stimulated posterior rootlet , anterior rootlet and sciatic nerve , showed minimal and maximal appea rance.The maximal response did not increase with the increasing stimulus intens ity.The damage of primary demyelination was extensive on the peripheral nerves and the pathological changes of myelinated nerve fibers were more obvious than t he nonmyelinated nerve fibers.Conclusion:It is feasi ble that using threshold of nerve rootlet identify the number of motorial ref lex circuit in the rootlet.