[1]樊娟,王晓东,苗素华,等.术中神经电生理监测对第5腰椎水平选择性脊神经后根切断术的影响研究[J].临床小儿外科杂志,2022,21(10):917-922.[doi:10.3760/cma.j.cn101785-202205022-004]
　Fan Juan,Wang Xiaodong,Miao Suhua,et al.Effect of intraoperative neurophysiological monitoring on lumbar 5 selective posterior rhizotomy in patients with cerebral palsy[J].Journal of Clinical Pediatric Surgery,2022,21(10):917-922.[doi:10.3760/cma.j.cn101785-202205022-004]
点击复制

术中神经电生理监测对第5腰椎水平选择性脊神经后根切断术的影响研究

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第21卷 期数: 2022年10期 页码: 917-922 栏目: 专题·神经电生理监测在小儿神经外科的应用 出版日期: 2022-10-28
Title:
Effect of intraoperative neurophysiological monitoring on lumbar 5 selective posterior rhizotomy in patients with cerebral palsy
作者:
樊娟1;  王晓东2;  苗素华1;  胡欣欣1;  陈瑶3;  陈莹1;  王济慈1;  王世杰1
1. 清华大学玉泉医院神经外科, 北京 100040;
2. 临沂圣博康复医院, 临沂 270617;
3. 清华大学玉泉医院麻醉科, 北京 100040
Author(s):
Fan Juan1;  Wang Xiaodong2;  Miao Suhua1;  Hu Xinxin1;  Chen Yao3;  Chen Ying1;  Wang Jici1;  Wang Shijie1
1. Department of Neurosugery, Yuquan Hospital, Tsinghua University, Beijing 100040, China;
2. Linyi Shengbo rehabilitation Rehabilitation Hospital, Linyi 270617, China;
3. Department of Anesthesiology, Yuquan Hospital, Tsinghua University, Beijing 100040, China
关键词:
脑性瘫痪; 脊神经根切断术; 神经电生理监测; 儿童
Keywords:
Cerebral Palsy; Rhizotomy; Neurophysiological Monitoring; Child
DOI:
10.3760/cma.j.cn101785-202205022-004
摘要:
目的 分析术中神经电生理监测对第5腰椎节段水平选择性脊神经后根切断术的影响,为探讨术中神经电生理监测对多节段选择性脊神经后根切断术的意义提供参考依据。方法 回顾性分析2020年11月至2022年3月清华大学玉泉医院收治的40例行第5腰椎选择性脊神经后根切断术的脑瘫患儿临床资料,依据术中是否进行神经电生理监测,分为未监测组(13例)和监测组(27例)。比较两组患儿第5腰椎脊神经后根切断比例、术前肌张力和术后肌张力改善情况。结果 未监测组左侧脊神经后根切断比例为(57±11)%,监测组左侧脊神经后根切断比例为(46±10)%,差异有统计学意义(P<0.05);未监测组右侧脊神经后根切断比例为(53±2)%,监测组右侧脊神经后根切断比例为(39±3)%,差异有统计学意义(P<0.05)。监测组和未监测组术前经表面肌电图测得的肌张力差异无统计学意义(P>0.05);两组手术后双侧腘绳肌、小腿三头肌肌张力的改善情况差异无统计学意义(P>0.05)。结论 对于脑瘫这类中枢神经损伤引起肢体肌张力增高的患儿,选择性脊神经后根切断术可有效改善症状,术中进行神经电生理监测,可以减少脊神经后根切断比例,同时不影响肌张力的改善,因而可望减少术后并发症和不必要的神经损伤。
Abstract:
Objective To explore the effect of intraoperative electrophysiological monitoring on transection proportion of lumbar 5 spinal nerve posterior root,examine the effect on muscle tonus of hamstring,and triceps muscle groups and provide reliable rationales for the significance of intraoperative electrophysiological monitoring on multi-level selective spinal nerve posterior rhizotomy.Methods From November 2020 to March 2022,clinical data was retrospectively reviewed for 40 cerebral palsy patients undergoing selective posterior rhizotomy of lumbar 5 segment.According to the absence and presence of intraoperative neurophysiological monitoring,they were divided into two groups of non-monitoring (n=13) and monitoring (n=27).Ratio of lumbar 5 spinal nerve posterior root transection,preoperative muscle tension and improvement rate of muscle tension were compared between two groups.Results The proportion of left spinal nerve posterior root transection in non-monitoring group was (57±11)% and (46±10)% in monitoring group.The difference had statistical significance (P<0.05).The proportion of right posterior spinal nerve root transection was (53±2)% in non-monitoring group and (39±3)% in monitoring group.The difference was statistically significant (P<0.05).No significant inter-group difference existed in muscle tension on preoperative surface electromyography (P>0.05).No significant inter-group difference existed in improvement rate of bilateral hamstring and triceps muscle tension (P>0.05).Conclusion Intraoperative neurophysiological monitoring of children undergoing selective posterior rhizotomy may reduce the proportion of rhizotomy without affecting the improvement rate of muscle tone.It minimizes postoperative complications and unnecessary nerve injuries.

参考文献/References:

[1] Fasano VA,Broggi G,Barolat-Romana G,et al.Surgical treatment of spasticity in cerebral palsy[J].Childs Brain,1978,4(5):289-305.DOI:10.1159/000119785.
[2] Peacock WJ,Staudt LA.Functional outcomes following selective posterior rhizotomy in children with cerebral palsy[J].J Neurosurg,1991,74(3):380-385.DOI:10.3171/jns.1991.74.3.0380.
[3] Peacock WJ,Arens LJ,Berman B.Cerebral palsy spasticity.Selective posterior rhizotomy[J].Pediatr Neurosci,1987,13(2):61-66.DOI:10.1159/000120302.
[4] Georgoulis G,Sindou M.Muscle responses to radicular stimulation during lumbo-sacral dorsal rhizotomy for spastic 1016/j.clinph.2020.02.007.
[5] Georgoulis G,Sindou M.Muscle responses to radicular stimulation during lumbo-sacral dorsal rhizotomy for spastic diplegia:Insights to myotome innervation[J].Clin Neurophysiol,2020,131(5):1075-1086.DOI:10.016/j.clinph.2020.02.007.
[6] 魏民,肖波.选择性脊神经后根切断术治疗痉挛型脑瘫的应用进展[J].临床小儿外科杂志,2019,18(12):1061-1066.DOI:10.3969/j.issn.1671-6353.2019.12.015.Wei M,Xiao B.Application progress of selective dorsal rhizotomy in the treatment of spastic cerebral palsy[J].J Clin Ped Sur,2019,18(12):1061-1066.DOI:10.3969/j.issn.1671-6353.2019.12.015.
[7] 苗素华,马羽,陈业涛,等.表面肌电图在脑瘫手术中的应用[J].中华神经外科杂志,2014,30(11):1157-1160.DOI:10.3760/cma.j.issn.1001-2346.2014.11.020.Miao SH,Ma Y,Chen YT,et al.Application of surface electromyography in evaluation effectiveness on spastic cerebral palsy[J].Chinese Journal of Neurosurgery,2014,30(11):1157-1160.DOI:10.3760/cma.j.issn.1001-2346.2014.11.020.
[8] Georgoulis G,Br?nzeu A,Sindou M.Dorsal rhizotomy for children with spastic diplegia of cerebral palsy origin:usefulness of intraoperative monitoring[J].J Neurosurg Pediatr,2018,22(1):89-101.DOI:10.3171/2018.1.PEDS17577.
[9] Sacco DJ,Tylkowski CM,Warf BC.Nonselective partial dorsal rhizotomy:a clinical experience with 1-year follow-Up[J].Pediatr Neurosurg,2000,32(3):114-118.DOI:10.1159/000028914.
[10] Cohen AR,Webster HC.How selective is selective posterior rhizotomy?[J].Surg Neurol,1991,35(4):267-272.DOI:10.1016/0090-3019(91)90003-r.
[11] Steinbok P,Keyes R,Langill L,et al.The validity of electrophysiological criteria used in selective functional posterior rhizotomy for treatment of spastic cerebral palsy[J].J Neurosurg,1994,81(3):354-361.DOI:10.3171/jns.1994.81.3.0354.
[12] Davidson B,Schoen N,Sedighim S,et al.Intrathecal baclofen versus selective dorsal rhizotomy for children with cerebral palsy who are nonambulant:a systematic review[J].J Neurosurg Pediatr,2019:1-9.DOI:10.3171/2019.8.PEDS19282.
[13] Staudt LA,Nuwer MR,Peacock WJ.Intraoperative monitoring during selective posterior rhizotomy:technique and patient outcome[J].Electroencephalogr Clin Neurophysiol,1995,97(6):296-309.DOI:10.1016/0924-980x (95)00128-8.
[14] Turner RP.Neurophysiologic intraoperative monitoring during selective dorsal rhizotomy[J].J Clin Neurophysiol,2009,26(2):82-84.DOI:10.1097/WNP.0b013e31819f9077.
[15] 詹琪佳,吴水华,肖波,等.新型神经电生理监测协议指导下微创入路选择性神经后根离断术治疗儿童痉挛型脑瘫的多中心临床研究[J].临床小儿外科杂志,2022,21(6):523-529.DOI:10.3760/cma.j.cn101785-202202065-005.Zhan QJ,Wu SH,Xiao B,et al.Short-term efficacy of single-level laminectomy selective dorsal rhizotomy guided by novel neuroelectro-physiological monitoring protocol for children with spastic cerebral palsy:a multicenter clinical trial[J].J Clin Ped Sur,2022,21(6):523-529.DOI:10.3760/cma.j.cn101785-202202065-005.
[16] Xiao B,Constatntini S,Browd SR,et al.The role of intra-operative nneuroelectrophysiological monitoring in single-level approach selective dorsal rhizotomy[J].Childs Nerv Syst,2020,36(9):1925-1933.DOI:10.1007/s00381-019-04408-5.
[17] De Vloo P,Huttunen TJ,Forte D,et al.Intraoperative electrophysiology during single-level selective dorsal rhizotomy:technique,stimulation threshold,and response data in a series of 145 patients[J].J Neurosurg Pediatr,2020,1-10.DOI:10.3171/2019.12.PEDS19372.
[18] Mittal S,Farmer JP,Poulin C,et al.Reliability of intraoperative electrophysiological monitoring in selective posterior rhizotomy[J].J Neurosurg,2001,95(1):67-75.DOI:10.3171/jns.2001.95.1.0067.
[19] Logigian EL,Soriano SG,Herrmann DN,et al.Gentle dorsal root retraction and dissection can cause areflexia:implications for intraoperative monitoring during "selective" partial dorsal rhizotomy[J].Muscle Nerve,2001,24(10):1352-1358.DOI:10.1002/mus.1155.

相似文献/References:

[1]孙圣礼 舒毓高 刘佳赋. 跳跃式椎板切除选择性脊神经后根切断治疗脑瘫性下肢痉挛9例[J].临床小儿外科杂志,2014,13(04):317.
[2]王玉欢,王加宽,李俊,等. 股骨头骨骺阻滞术早期干预痉挛性脑瘫髋关节发育不良的疗效分析[J].临床小儿外科杂志,2018,17(12):917.
　Wang Yuhuan,Wang Jiakuan,Li Jun,et al. Efficacies of capital femoral epiphysiodesis in early intervention for hip dysplasia of spastic cerebral palsy.[J].Journal of Clinical Pediatric Surgery,2018,17(10):917.
[3]顾振坤,付桂兵,唐盛平.脑瘫儿童髋关节监测与治疗进展[J].临床小儿外科杂志,2023,22(04):393.[doi:10.3760/cma.j.cn101785-202203033-018]
　Gu Zhenkun,Fu Guibing,Tang Shengping.Hip surveillance and treatment in children with cerebral palsy[J].Journal of Clinical Pediatric Surgery,2023,22(10):393.[doi:10.3760/cma.j.cn101785-202203033-018]
[4]魏民,肖波.选择性脊神经后根切断术治疗痉挛型脑瘫的应用进展[J].临床小儿外科杂志,2019,18(12):1061.[doi:10.3969/j.issn.1671-6353.2019.12.015]
　Wei Min,Xiao Bo.Application progress of selective dorsal rhizotomy in the treatment of spastic cerebral palsy[J].Journal of Clinical Pediatric Surgery,2019,18(10):1061.[doi:10.3969/j.issn.1671-6353.2019.12.015]
[5]肖波,蒋文彬,王君璐,等.诱发肌电在脑瘫患儿选择性脊神经后根离断术中的应用进展[J].临床小儿外科杂志,2022,21(10):901.[doi:10.3760/cma.j.cn101785-202206009-001]
　Xiao Bo,Jiang Wenbing,Wang Junlu,et al.Application of evoked electromyography in selecting spinal nerve roots during selective dorsal rhizotomy[J].Journal of Clinical Pediatric Surgery,2022,21(10):901.[doi:10.3760/cma.j.cn101785-202206009-001]
[6]王国庆,王君璐,蒋文彬,等.脑电双频指数在单椎板入路选择性神经后根离断术中的应用[J].临床小儿外科杂志,2022,21(10):947.[doi:10.3760/cma.j.cn101785-202205053-009]
　Wang Guoqing,Wang Junlu,Jiang Wenbin,et al.Application of bispectral index during single-level selective dorsal rhizotomy[J].Journal of Clinical Pediatric Surgery,2022,21(10):947.[doi:10.3760/cma.j.cn101785-202205053-009]

备注/Memo

收稿日期:2022-5-27。
基金项目:北京市科技项目(Z211100003521006)
通讯作者:王世杰,Email:wjr215@163.com

更新日期/Last Update: 1900-01-01