选择性脊神经后根部分切断术对下肢痉挛性瘫痪患儿血清TGF-β1和NSE水平的影响
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摘要
目的:探讨选择性脊神经后根部分切断术对下肢痉挛性瘫痪患儿的治疗效果及血清转化生长因子β1(TGF-β1)、神经元特异性烯醇化酶(NSE)水平的影响。方法:52例下肢痉挛性瘫痪患儿,均行选择性脊神经后根部分切断术治疗;术前及术后2周时,采用改良Ashworth分级法评定患儿患侧下肢腘绳肌、小腿三头肌群及髋内收肌群的肌张力,采用酶联免疫吸附法检测患儿的血清TGF-β1、NSE水平,采用质子磁共振波谱分析患儿基底节区代谢产物水平,同时比较术前及术后1周时患儿的下肢浅感觉。结果:术后2周时,患儿腘绳肌、小腿三头肌群及髋内收肌群的Ashworth分级0级、Ⅰ级患儿比例较术前显著增加,Ⅲ级、Ⅳ级患儿比例均较术前显著减少(P <0. 05),患儿患侧下肢腘绳肌、小腿三头肌群及髋内收肌群的肌张力显著改善;患儿术后2周时的TGF-β1水平较术前显著升高,NSE水平较术前显著降低(P <0. 05);患儿手术前同侧、对侧及术后2周时同侧的Cho/Cr、NAA/Cr及Cho/NAA比值、术后2周时对侧的Cho/Cr比值分别比较,差异无统计学意义(P> 0. 05),对侧的NAA/Cr比值较术前显著降低、Cho/NAA比值较术前显著升高(P <0. 05);术后1周时,患儿的浅痛觉级别较术前显著上升(P <0. 05)、触觉次数及温感觉级别与术前比较,差异无统计学意义(P> 0. 05)。结论:选择性脊神经后根部分切断术治疗下肢痉挛性瘫痪患儿效果满意,可显著改善患儿腘绳肌、小腿三头肌群及髋内收肌群的张力,其机制可能与手术调节了血清TGF-β1、NSE水平及对侧基底节区代谢产物有关。
Objective: To investigate the clinical efficacy of selective posterior spinal nerve root resection onlower limbs in children and the effects on serum transforming growth factor-β1( TGF-β1)and neuron-specific enolase( NSE) levels in them. Methods: 52 children with spastic paralysis of the lower extremity admitted to our hospital from October 2015 to October 2017,all patients underwent selective treatment of posterior roots of the spinal nerve. The clinical efficacy of the patients after treatment was recorded. The serum TGF-β1,NSE levels and metabolite levels in the basal ganglia were counted before and after treatment. Results: Compared with preoperative,the hamstrings,calf triceps,hip adduction muscle group of Ashworth class 0,Ⅰ proportion of children patients increased significantly at 2 weeks postoperatively,Ⅲ,Ⅳ proportion were significantly less than preoperative( P <0. 05). The muscle tones of hamstrings,triceps and adductors of the lower limbs and legs were significantly improved. The TGF-1 level was significantly higher than that of preoperative at 2 weeks after surgery,and the NSE level was significantly lower than that before surgery( P < 0. 05). Cho/Cr,NAA/Cr and Cho/NAA ratios of the same side before surgery,the opposite side and the same side at 2 weeks after surgery were compared respectively,the differences were not statistically significant( P >0. 05). The contralateral NAA/Cr ratio was significantly lower than that before surgery while the Cho/NAA ratio was significantly higher than that before surgery( P < 0. 05); compared with that before surgery,the level of superficial pain of the children increased significantly at 1 week after surgery( P <0. 05); the number of tactile sensation and the level of temperature sensation were compared with those before surgery,the difference was not statistically significant( P > 0. 05). Conclusion: For children with lower extremity spasticity,the treatment of selective posterior root resection of the spinal nerve is satisfactory,which can significantly improve the tension of the hamstring,calf triceps and hip adductor muscles,regulate TGF-β1,NSE levels and contralateral basal ganglia metabolites.
Objective: To investigate the clinical efficacy of selective posterior spinal nerve root resection onlower limbs in children and the effects on serum transforming growth factor-β1( TGF-β1)and neuron-specific enolase( NSE) levels in them. Methods: 52 children with spastic paralysis of the lower extremity admitted to our hospital from October 2015 to October 2017,all patients underwent selective treatment of posterior roots of the spinal nerve. The clinical efficacy of the patients after treatment was recorded. The serum TGF-β1,NSE levels and metabolite levels in the basal ganglia were counted before and after treatment. Results: Compared with preoperative,the hamstrings,calf triceps,hip adduction muscle group of Ashworth class 0,Ⅰ proportion of children patients increased significantly at 2 weeks postoperatively,Ⅲ,Ⅳ proportion were significantly less than preoperative( P <0. 05). The muscle tones of hamstrings,triceps and adductors of the lower limbs and legs were significantly improved. The TGF-1 level was significantly higher than that of preoperative at 2 weeks after surgery,and the NSE level was significantly lower than that before surgery( P < 0. 05). Cho/Cr,NAA/Cr and Cho/NAA ratios of the same side before surgery,the opposite side and the same side at 2 weeks after surgery were compared respectively,the differences were not statistically significant( P >0. 05). The contralateral NAA/Cr ratio was significantly lower than that before surgery while the Cho/NAA ratio was significantly higher than that before surgery( P < 0. 05); compared with that before surgery,the level of superficial pain of the children increased significantly at 1 week after surgery( P <0. 05); the number of tactile sensation and the level of temperature sensation were compared with those before surgery,the difference was not statistically significant( P > 0. 05). Conclusion: For children with lower extremity spasticity,the treatment of selective posterior root resection of the spinal nerve is satisfactory,which can significantly improve the tension of the hamstring,calf triceps and hip adductor muscles,regulate TGF-β1,NSE levels and contralateral basal ganglia metabolites.
引文
[1]D’AQUINO D,MOUSSA A A,AMMAR A,et al. Selective dorsal rhizotomy for the treatment of severe spastic cerebral palsy:efficacy and therapeutic durability in GMFCS grade IV and V children[J]. Acta Neurochirurgica,2018,160(4):811-821.
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[5]胡栓贵,黄进能,范学政,等.选择性脊神经后根切断术治疗脑瘫性下肢痉挛41例临床分析[J].立体定向和功能性神经外科杂志,2015,28(4):197-199.
[6]杜爱民,孙成彦,彭云川,等.腰骶部功能性选择性脊神经后根切断术治疗痉挛性脑瘫的效果[J].中国医药导报,2015,12(24):158-161.
[7]吴鹤鸣,李鸣.选择性脊神经后根切断术治疗痉挛性脑瘫现状及其进展[J].中国临床研究,2015,28(4):529-531.
[8]陈章明,周孙章.选择性脊神经后根切断术配合强制性诱导运动训练对脑性瘫痪患儿肢体功能及血清学指标的影响[J].海南医学,2015,26(6):816-819.
[9]SIMON N G,LEE M,BAE J S,et al. Dissociated lower limb muscle involvement in amyotrophic lateral sclerosis[J]. Journal of Neurology,2015,262(6):1424-1432.
[10]BIALECKI J,NOWAKMISIAK M,RPALA K,et al. Spinal tuberculosis with severe neurological symptoms as a complication of intravesical BCG therapy for carcinoma of the bladder[J]. Neurologia I Neurochirurgia Polska,2016,50(2):131-138.
[11]贾拥政,肖玉周,杨文彬.腰骶部选择性脊神经后根切断术治疗下肢痉挛性大脑性瘫痪中远期疗效评估[J].中国修复重建外科杂志,2013,27(11):1345-1349.
[12]木塔力甫,努热合买提,闫宝锋,等.圆锥部选择性脊神经后根部分切断术治疗下肢痉挛型脑性瘫痪的疗效分析[J].中华实用儿科临床杂志,2016,31(23):1813-1816.
[13]艾克拜尔·哈里克,逯霞,木塔力甫·努热合买提,等.不同剂量右美托咪定在脑瘫患儿选择性腰骶部脊神经后根切断术中的应用[J].中国现代手术学杂志,2017,21(1):73-76.
[14]邵旭,于炎冰,张黎,等.腰骶段选择性脊神经后根切断术治疗脑瘫性下肢痉挛状态手术并发症[J].北京大学学报(医学版),2015,47(1):160-164.
[15]赵东升,姬西团,费舟,等.高选择性脊神经后根切断术治疗痉挛性脑瘫[J].中华神经外科疾病研究杂志,2014,13(2):153-155.
[16]TARIQ H,MUKHTAR S,NAZ S. A novel mutation in ALS2 associated with severe and progressive infantile onset of spastic paralysis[J]. Journal of Neurogenetics,2017,32(12):1-4.
[17]ROMEI M,OUDENHOVEN L M,PEM V S,et al. Evolution of gait in adolescents and young adults with spastic diplegia after selective dorsal rhizotomy in childhood:A10 year follow-up study[J]. Gait&Posture,2018,64:108-113.
[18]王凤鹿,陈明生,赵海康.腰骶部FSPR治疗脑卒中所致下肢痉挛性瘫痪的临床疗效[J].中国临床神经外科杂志,2018,23(8):535-536; 539.
[19]艾克拜尔·哈里克,逯霞,木塔力甫·努热合买提,等.肌电图引导下A型肉毒素与选择性脊神经后根切断术治疗痉挛型脑瘫的效果比较[J].中国医药导报,2017,14(17):54-57.
[2]TANG K T,MICHAEL S M. Gait analysis before and after selective dorsal rhizotomy in patients with spastic diplegic cerebral palsy[J]. Gait&Posture, 2014,39:S105-S106.
[3]艾克拜尔·哈里克,逯霞.选择性脊神经后根部分切断术治疗下肢痉挛性瘫痪的疗效及血清NSE、转化生长因子β1浓度的变换[J].中国现代手术学杂志,2017,21(2):149-152.
[4]段宇,张发永.选择性脊神经根部分切断术对痉挛性偏侧肢体脑瘫患儿基底节区脑代谢影响[J].中风与神经疾病杂志,2016,33(10):882-885.
[5]胡栓贵,黄进能,范学政,等.选择性脊神经后根切断术治疗脑瘫性下肢痉挛41例临床分析[J].立体定向和功能性神经外科杂志,2015,28(4):197-199.
[6]杜爱民,孙成彦,彭云川,等.腰骶部功能性选择性脊神经后根切断术治疗痉挛性脑瘫的效果[J].中国医药导报,2015,12(24):158-161.
[7]吴鹤鸣,李鸣.选择性脊神经后根切断术治疗痉挛性脑瘫现状及其进展[J].中国临床研究,2015,28(4):529-531.
[8]陈章明,周孙章.选择性脊神经后根切断术配合强制性诱导运动训练对脑性瘫痪患儿肢体功能及血清学指标的影响[J].海南医学,2015,26(6):816-819.
[9]SIMON N G,LEE M,BAE J S,et al. Dissociated lower limb muscle involvement in amyotrophic lateral sclerosis[J]. Journal of Neurology,2015,262(6):1424-1432.
[10]BIALECKI J,NOWAKMISIAK M,RPALA K,et al. Spinal tuberculosis with severe neurological symptoms as a complication of intravesical BCG therapy for carcinoma of the bladder[J]. Neurologia I Neurochirurgia Polska,2016,50(2):131-138.
[11]贾拥政,肖玉周,杨文彬.腰骶部选择性脊神经后根切断术治疗下肢痉挛性大脑性瘫痪中远期疗效评估[J].中国修复重建外科杂志,2013,27(11):1345-1349.
[12]木塔力甫,努热合买提,闫宝锋,等.圆锥部选择性脊神经后根部分切断术治疗下肢痉挛型脑性瘫痪的疗效分析[J].中华实用儿科临床杂志,2016,31(23):1813-1816.
[13]艾克拜尔·哈里克,逯霞,木塔力甫·努热合买提,等.不同剂量右美托咪定在脑瘫患儿选择性腰骶部脊神经后根切断术中的应用[J].中国现代手术学杂志,2017,21(1):73-76.
[14]邵旭,于炎冰,张黎,等.腰骶段选择性脊神经后根切断术治疗脑瘫性下肢痉挛状态手术并发症[J].北京大学学报(医学版),2015,47(1):160-164.
[15]赵东升,姬西团,费舟,等.高选择性脊神经后根切断术治疗痉挛性脑瘫[J].中华神经外科疾病研究杂志,2014,13(2):153-155.
[16]TARIQ H,MUKHTAR S,NAZ S. A novel mutation in ALS2 associated with severe and progressive infantile onset of spastic paralysis[J]. Journal of Neurogenetics,2017,32(12):1-4.
[17]ROMEI M,OUDENHOVEN L M,PEM V S,et al. Evolution of gait in adolescents and young adults with spastic diplegia after selective dorsal rhizotomy in childhood:A10 year follow-up study[J]. Gait&Posture,2018,64:108-113.
[18]王凤鹿,陈明生,赵海康.腰骶部FSPR治疗脑卒中所致下肢痉挛性瘫痪的临床疗效[J].中国临床神经外科杂志,2018,23(8):535-536; 539.
[19]艾克拜尔·哈里克,逯霞,木塔力甫·努热合买提,等.肌电图引导下A型肉毒素与选择性脊神经后根切断术治疗痉挛型脑瘫的效果比较[J].中国医药导报,2017,14(17):54-57.