摘要
目的探讨术中肌电图监测在儿童脊髓栓系松解术中的作用。方法收集2017年11月至2018年6月由苏州大学附属儿童医院神经外科确诊为脊髓栓系并行栓系松解术的61例患儿作为研究对象,回顾性分析术中肌电图监测结果及术后随访结果。结果 61患儿均完全松解栓系,肌电图监测下均辨别出L5、S1、S2神经根。1例右下肢肌力0级患儿术中肌电图监测患侧肌电图较对侧明显低平,但可以使用诱发肌电记录;术中肌电图监测可以及时提示术者避免发生持续性过度牵拉引起的肌电反射;使用叉状双极探头探查粘连部位与神经根关联情况,辨别各神经根走向,明确S2位置。术后随访3～11个月,1例患儿(脂肪瘤型)术后次日出现尿储留,经导尿15 d后恢复至术前,随访期间无症状加重患儿。19例大小便功能异常患儿中5例改善,14例无改变,无加重病例。11例下肢功能障碍患儿中9例改善,2例无变化,无加重病例。33例脂肪瘤型脊髓栓系患儿术前脊髓直径/硬脊膜囊直径(CORD/SAC)为(0. 78±0. 03),术后CORD/SAC为(0. 41±0. 02),差异有统计学意义(t=12. 78,P <0. 001)。结论术中肌电图监测可以实时监测手术操作对神经的干扰情况,可以辨别神经根粘连情况及明确失活的神经根,减少手术操作对神经的损伤,最大可能地松解栓系。在脂肪瘤型脊髓栓系患儿手术中可最大程度切除脂肪瘤,有效降低CORD/SAC值,减少术后粘连。
Objective To explore the effect of electromyography (EMG) monitoring during spinal loosening for tethered cord syndrome (TCS) in children. Methods From November 2017 to June 2018,clinical data were reviewed for 61 children of tethered cord diagnosed neurosurgically.Intraoperative EMG monitoring was performed and postoperative follow-ups were conducted. Results The nerve roots of L5,S1 and S2 were identified by EMG monitoring.Affected side of one patient with a zero level of muscle strength of right lower extremity was significantly lower than that of opposite side.However,induced EMG recording could be used.During operation,it prompted the operator to avoid continuous over-stretch myoelectric reflex.Fork bipolar probe was employed for detecting the correlation between adhesion site and nerve roots and identifying the direction of each nerve root.The postoperative follow-up period was 3 to 11 months.Urinary retention occurred in one case (lipoma type),but recovered to the preoperative period after 14-day urinary catheterization.Among 19 cases of dyspraxia,the outcomes were improvement (n=5) and no change/aggravation (n=14);among 11 cases of lower limb dysfunction,improvement (n=9) and no change/aggravation (n=2).The ratio of CORD/SAC was (0.78±0.03) before surgery and (0.41±0.02) after surgery.And the difference was statistically significant (t=12.78,P<0.001). Conclusion Intraoperative EMG can monitor intraoperative nerve interference in real-time,identify nerve root adhesion,detect inactivated nerve root,reduce intraoperative nerve damage and release tethered cord.
作者
王勇强
陈民
王杭州
Wang Yongqiang;Chen Min;Wang Hangzhou(Department of Neurosurgery,Affiliated Children's Hospital,Soochow University,Suzhou 215025)
出处
《临床小儿外科杂志》
CAS
2018年第12期922-926,共5页
Journal of Clinical Pediatric Surgery
关键词
脊髓栓系
肌电图
神经电生理监测
儿童
Tethered Spinal Cord
Electromyograph
Neuroelectrophysiological Monitoring
Child
