SPR治疗成人脊髓损伤后肢体痉挛的临床及电生理观测

Clinical and electronic physiology observation about the treatment of spastic limbs of spinal cord injury with selective posterior rhizotomy

目的 :对选择性脊神经后根切断术 (SPR)治疗成人脊髓损伤后肢体痉挛的疗效进行观察 ,并探讨手术前后诱发电位的变化对SPR的意义。方法 :对胸椎压缩性骨折致脊髓损伤 (30例 )及脊柱结核后期 (1 1例 )出现肢体痉挛的患者行L2～S1双侧节段开窗式椎板切除 ,将L2～S1的脊神经后根进行分束 ,电刺激仪测阈值 ,将阈值较低的神经束切断 ,神经根切断比例结合肌张力、肌力、体重及肌群功能进行量化 ,均 <30 %。术前 3d及术后 2 1d行诱发电位测定。结果 :经平均 5年随访 ,41例病人痉挛解除率 90 % ,功能改善率 75 %。术后皮层SEP波幅降低 ,感觉神经传导速度减慢 ,手术前后有显著差异 (P <0 0 1 )。结论 :选择性脊神经后根切断术能较有效地治疗成人脊髓损伤后肢体痉挛。手术前后诱发电位测定支持肌张力调节“大、小环路”理论 。

Objective:Using selective posterior rhizotomy(SPR)to treat spastic limbs after spinal cord injury,and study the evoked potential to the result of SPR.Method:By fenestrated lamina resection from L2～S1,the posterior roots of spinal cord of spastic limbs were divided into branches.Cutting cut down the lower threshold branch detected during the operation.The ratio of cut root was estimated,by muscle tension,myodynamia,body weight and muscle function and all of them <30%.Evoked potential was measured on the 3d before operation and the 21d after operation.Result:Using SPR to treat 41 case of spastic limbs with spinal cord lnjury.After following up for 5 years,the remove rate of spasm was 90%,and function improvement rate was 75%.Amplitude of wave of cortex SEP decreased after operation,and velocity of sensory nerve conduction was slower than that of pre operation.There was significant difference between beftore and after operation( P <0.01%).Conclusion:The effect of using SPR to treat spastic limbs of spinal cord injury is satisfying.The muscular tension regulation of'large and small circle'theory and the mechanism of spastic limbs after spinal cord injury are supported by the evoked potential before and after operation.