痉挛性肌张力增高的神经外科治疗

Nerve Surgical Treatment of Spastic High Muscle Tension

目的:分析总结在周围神经肌电监测指导下行缩窄神经术降低痉挛性高肌张力,改善关节强直的临床疗效。方法:对16例关节强直患者术中在周围神经肌电监测指导下,在显微镜下行神经缩窄术,其中脑性瘫痪患者9例,脑炎后遗症患者2例,中毒性脑病1例,脑外伤后遗症患者1例,颈髓损伤患者1例,脑积水患者1例,烟雾病伴脑梗死患者1例。用表面肌电(surface electro myo graphy,s EMG)及改良的Ashworth(Modified A shworth Scale,MAS)肌张力分级标准对强直肢体肌张力评定。结果:所有患者的痉挛肢体肌张力明显下降,症状显著改善。肌电信号均方根值术前与术后比较,采用配对样本的T检验分析,P值<0.001,差异有统计学意义。术后感觉障碍发生率为12.5%(2/16),术后肌力明显减低发生率为18.8%(3/16),随访期间完全恢复。结论:术中在周围神经肌电监测指导下,显微镜下行神经缩窄术治疗痉挛性关节强直是有效的外科治疗方法,效果确切。

Objective： To assess the treatment outcome of peripheral nerve neurotomy after applying electromechanical monitoring to decrease spastic high muscle tension in patients with ankylosis. Methods： With the use of electromechanical monitoring of peripheral nerve, the peripheral nerve neurotomy was performed under microscope on 16 patients with ankylosis. Among these patients,there were nine cerebral palsy patients, two patients with postencephalitis, one patient with toxic encephalopathy, one patient with post-traumatic brain syndrome, one patient with spinal cord damage, one patient with hydrocephalus and one patient with moya disease complicated with cerebral infarction. The ankylotic limbs were tested with surface electromyography（s EMG） and modified ashworth scale（MAS）. Results： The muscle tension of all patients＇ spastic limbs was apparently decreased, and the symptoms were improved significantly. Comparison of the root mean square value of EMG signal before and after operation, the difference was statistically significant, P〈0.001. After operation, 12.5 % patients suffered the sensory dysfuction, while 18.8 % patients got significant lower muscle strength degree, and all the patients was found fully rehabilitation during the follow-up period. Conclusions： Peripheral nerve neurotomy in the direction of electromechanical monitoring is an effective surgical method to treat spastic ankylosis.