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):901-906.[doi:10.3760/cma.j.cn101785-202206009-001]
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
- Title:
- Application of evoked electromyography in selecting spinal nerve roots during selective dorsal rhizotomy
- Keywords:
- Cerebral Palsy; Paraparesis; Spastic; Rhizotomy; Neurophysiological Monitoring; Electromyography
- 摘要:
- 脊神经后根离断能有效抑制痉挛性脑性瘫痪患儿处于兴奋-抑制失衡状态的脊髓前角α运动神经元兴奋性,从而达到降低其对应肌群肌张力、改善患儿运动功能的目的。但由于人体仅双下肢感觉相关的脊神经后根就有数十枚,如何精准选择需要毁损的脊神经后根一直是临床面临的棘手问题。脊神经诱发肌电监测为这一难题提供了极具操作性的解决方案,为获得稳定及有效的诱发肌电数据,选择性神经后根离断术(selective dorsal rhizotomy,SDR)中麻醉程度、监测肌群及电刺激参数等有一定的规范和要求。串刺激及单刺激是目前较为常用的肌电诱发刺激模式。刺激模式不同,会导致对于脊神经后根的最终"选择"不同。因此,探寻一个安全、有效、量化并能适度降低痉挛肌群肌张力的术中脊神经后根"选择"方案是SDR手术及术中神经电生理监测团队未来的研究方向。
- Abstract:
- Partially resecting some spinal dorsal nerve roots can effectively lower abnormally heightened excitability of α motor neurons in anterior horns of spinal cord,directly causing corresponding muscle spasticity in patients with spastic cerebral palsy.Therefore such surgical procedure has potentials of reducing muscle tone of spastic muscles and improving motor functions.Due to the fact that several scores of root candidates are associated with sensory input from lower extremities in each case,precisely "selecting" roots for sectioning stays always at the core of surgery.Evoked electromyography (EMG),as one modality of intra-operative neurophysiological monitoring,is offering a practical approach to accomplish the task of "precise selection" of nerve root.For acquiring stable and interpretable evoked EMG data during selective dorsal rhizotomy (SDR),some requirements should be fulfilled.For example,an appropriate depth of anesthesia,muscle group selection for monitoring and proper electrical stimulation parameters.Train and single-pulse stimulation are currently the two most practiced stimulation patterns.Applying different stimulation patterns may lead to a different selection of nerve roots for resecting.Our objective was to formulate an intra-operative evoked EMG interpretation protocol of guiding more precisely to attain the goal of "selection" during SDR.
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备注/Memo
收稿日期:2022-6-6。
基金项目:上海市科学技术委员会"科技创新行动计划"项目(20Y11905800)
通讯作者:詹琪佳,Email:hanbing_1125@163.com