躯体感觉诱发电位在痉挛型脑瘫患儿选择性后根阻断术中应用价值

The clinical effect of somatosensory evoked potential on selective posterior rhizotomy of the children with spastic cerebral palsy

目的评估痉挛型脑瘫患儿接受选择性后根阻断术(SPR)中应用躯体感觉诱发电位技术(SEP)的临床疗效及预后评估价值。方法选择我院脑瘫中心42例接受SPR治疗的痉挛型脑瘫患儿进行前瞻性研究,依据随机原则分为:对照组,21例,术中未接受SEP;研究组,21例,术中予以SEP监测。治疗1月后比较两组患者临床症状、肌张力改善以及粗大运动功能分级(GMFCS分级)情况。分析SEP监测对评估接受SPR痉挛型脑瘫患儿发生神经功能障碍的诊断价值。随访3月比较两组的不良反应发生率的差异。结果研究组的步态功能改善率、关节屈曲减轻率以及反射亢进改善率均显著高于对照组(P<0.05)。研究组的各肌群肌张力以及GMFCS评分显著低于对照组(P<0.05)。依据术中SEP预警标准评估接受SPR痉挛型脑瘫患儿发生神经功能障碍的敏感度为52.4%,特异度为38.1%,准确度为90.5%。随访3月,研究组的肢体痉挛复发、腰椎前凸、一过性肌无力、一过性肢体感觉障碍以及一过性尿潴留显著低于对照组(P<0.05)。结论接受SPR痉挛型脑瘫患儿应用SEP监测能有效改善患者症状,避免神经功能损伤,准确度及安全性好。

Objective To evaluate the clinical effect and the prognostic value of somatosensory evoked potential（SEP）monitoring on selective posterior rhizotomy（SPR）of the children with spastic cerebral palsy（SCP）.Methods 42 children diagnosed to SCP received the SPR in cerebral palsy center of our hospital were collected to prospective study.All children were divided into two groups based on the randomly principal,which were control group（21 cases,never received the SEP monitoring in the operation）and research group（21 cases,received the SEP monitoring in the operation）.After one month therapy,the improved degrees of clinical symptoms and muscular tension and the gross motor function classification system（GMFCS）were compared between two groups.The diagnostic value of SEP monitoring on SPR of the children with SCP were analyzed.Follow-up 3 months,the occurrences of adverse reaction were compared between two groups.Results The indexes of gait function improvement rate,joint flexion relieve rate and hyperreflexia improvement rate in research group were higher than in control group（P〈0.05）.The muscular group tensions and the degrees of GMFCS in research group were lower than in control group（P〈0.05）.The sensitivity of SEP monitoring on SPR of the children with SCP based on the alarm standard was 52.4%,the specificity was 38.1%and the accuracy was 90.5%.Followup 3 months,the occurrences of recurrent spastic limb,lumbar lordosis,transient myasthenia,transient limb sensory disorder and transient urinary retention n research group were lower than in control group（P〈0.05）.Conclusion The SEP monitoring on SPR of the children with SCP can efficiently improve the clinical symptoms and avoid the damage of nerve function.And the accuracy and the safety are perfect.