痉挛性肌张力增高的神经外科治疗
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摘要
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.
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.
引文
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[20]王世杰,崔志强,殷天樵,等.周围神经缩窄术在治疗脑瘫痉挛肢体中的应用[J].中华神经外科杂志,2006,22(5):293-295Wang Shi-jie,Cui Zhi-qiang,Yin Tian-qiao,et al.Peripheral nerve narrowed technique application in the treatment of cerebral palsy spasm limbs[J].Chinese Journal of Neurosurgery,2006,22(5):293-295
[2]Bolster EAM,Van Schie PEM,Becher JG.Long-term effect of selective dorsal rhizotomy on gross motor function in ambulant children with spastic bilateral cerebral palsy compared with reference centiles[J].Developmental Medicine and Child Neurology,2013,55(7):610-616
[3]Bollens B,Deltombe T,Detrembleur C.Effects of selective tibial nerve neurotomy as a treatment for adults presenting with spastic equinovarus foot:a systematic review[J].Journal of rehabilitation medicine,2011,43(4):277-282
[4]Buffenoir K,Rigoard P,Ferrand-Sorbets S.Retrospective study of the long-term results of selective peripheral neurotomy for the treatment of spastic upper limb[J].Neuro-Chirurgie,2009,55(1):150-160
[5]Woon K,Tsegaye M,Vloeberghs MH.The role of intrathecal baclofen in the management of primary and secondary dystonia in children[J].British Journal of Neurosurgery,2007,21(4):355-358
[6]Erik J,Gerwin M.Treatment of swan neck deformity in cerebral palsy[J].The Journal of hand surgery,2014,39(4):768-772
[7]Patterson JMM,Wang AA,Hutchinson DT.Late deformities following the transfer of the flexor carpi ulnaris to the extensor carpi radialis brevis in children with cerebral palsy[J].The Journal of hand surgery,2010,35(11):1774-1778
[8]Li M,Liu X,Yue H,et al.Transplantation of N-acetyl aspartylglutamate synthetase-activated neural stem cells after experimental traumatic brain injury significantly improves neurological recovery[J].Cell Physiol Biochem,2013,32(6):1776-1789
[9]Barha CK,Ishrat T,Epp JR,et al.Progesterone treatment normalizes the levels of cell proliferation and cell death in the dentate gyrus of the hippocampus after traumatic brain injury[J].Experimental neurology,2011,231(1):72-81
[10]Thamkunanon V.Improvement of ambulatory function with multilevel soft tissue surgery in children with spastic diplegic cerebral palsy[J].Journal of the Medical Association of Thailand=Chotmaihet thangphaet,2011,94(3):183-188
[11]Rosenow J,Staats P.Prospective 12-month study of intrathecal baclofen therapy for poststroke spastic upper and lower extremity motor control and functional improvement[J].Neuromodulation:journal of the International Neuromodulation Society,2011,14(1):38-45
[12]Lipták J.Comparative effectiveness of different muscle relaxants in the rehabilitation of post-stroke patients with spasticity[J].Ideggyógyászati szemle,2013,66(11-12):429
[13]Bohannon RW,Smith MB.Interrater reliability of a modified Ashworth scale of muscle spasticity[J].Physical Therapy,1987,67(2):206-207
[14]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):1157-1160Miao Su-hua,Ma yu,Chen Ye-tao,et al.The use of methods of surface electromyography in cerebral palsy[J].Chinese Journal of Neurosurgery,2014,30(11):1157-1160
[15]Fridman EA,Crespo M,Gomez Argüello S,et al.Kinematic improvement following Botulinum Toxin-A injection in up per-limb spasticity due to stroke[J].Journal of neurology,neurosurgery,and psychiatry,2010,81(4):423-427
[16]Basaran A,Emre U,Karadavut KI,et al.Somatosensory evoked potentials of hand muscles in stroke and their modification by botulinum toxin:a preliminary study[J].Journal of rehabilitation medicine:official journal of the UEMS European Board of Physi cal and Rehabilitation Medicine,2012,44(7):541-546
[17]Laurent K,De Sèze MP,Delleci C,et al.Assessment of quality of life in stroke patients with hemiplegia[J].Annals of physical and rehabilitation medicine,2011,54(6):376-390
[18]Matsumoto S,Shimodozono M,Etoh S,et al.Beneficial effects of footbaths in controlling spasticity after stroke[J].International journal of biometeorology,2010,54(4):465-473
[19]Fasano VA,Broggi G,Barolat Romana G,et al.Surgical treatment of spasticity in cerebral palsy[J].Child Brain,1978,4(5):289-305
[20]王世杰,崔志强,殷天樵,等.周围神经缩窄术在治疗脑瘫痉挛肢体中的应用[J].中华神经外科杂志,2006,22(5):293-295Wang Shi-jie,Cui Zhi-qiang,Yin Tian-qiao,et al.Peripheral nerve narrowed technique application in the treatment of cerebral palsy spasm limbs[J].Chinese Journal of Neurosurgery,2006,22(5):293-295