痉挛型脑性瘫痪患儿脊神经背根病理改变与临床意义

The relationship between pathological changes of spinal nerve root and manifestation in patients with cerebral palsy

目的研究痉挛型脑性瘫痪(脑瘫)患儿脊神经后根病理改变与临床的关系。方法选择经临床确诊的痉挛型脑瘫患儿27例,采用选择性脊神经根切断术(SPR)切断L5～S1两侧脊神经后根,对标本进行计算机辅助图象分析处理,测定各种指标与患儿Ashworth肌张力分级的关系。结果所有脑瘫患儿手术切除的脊神经后根均有不同程度的病理改变,以粗有髓神经纤维病变明显,主要为脱髓鞘病变。无髓神经纤维以其周围的雪旺氏细胞病变为主,神经受损无修复与再生。髓鞘厚度、病理改变程度与Ashworth肌张力分级正相关。结论脊神经后根的病理变化是继发性退行性改变,这种改变与Ashworth肌张力分级有关。

Objective To investigate the pathological changes of spinal nerve root and its correlation with clinical manifestations and the duration of disease in patients with cerebral palsy (CP).Methods Twenty seven cases of spastic cerebral palsy were divided into four groups according to Ashworth muscular tension grading.Bilateral dorsal root of spinal nerve of L5～S1 which had a low threshold of muscle spasm induced by electric stimulation were resected in selective posterior rhizotomy (SPR) with the ratio of 50%.The resected nerve root was prepared for light microscopy and transmission electron microscopy (TEM) examination with computer assisted image analysis.The diameter of neurite, the diameter of nerve fiber, g ratio (the ratio of neurite vs. nerve fiber) and the mean thickness of myelin sheath were determined with the method of morphology and statistical analysis.The correlations between the indexes listed above and Ashworth grading of the patients were analyzed.Results Pathological changes of different degree were found in all resected specimens.The conspicuous pathological change was the demyelination of thick nerve fibers.The lesion of Schwann cells dominated the nonmyelinated verve fibers. No repair or regeneration was observed in the pathological lesions.With the Spearman test, the diameter of neurite,the diameter of nerve fiber and the thickness of myelin sheath showed positive correlation with age. The degree of pathological lesion was correlated with Arsworth grading but was not correlated with the age of patients.Conclusion The pathological lesion of peripheral nerves was correlated with Ashworth muscular tension grading system, but was not correlated with the duration of the disease.