CAJ | 학술논문

目的利用神经电生理检测技术分析脊髓栓系综合征(tethered cord syndrome,TCS)患儿盆底神经和肌肉功能改变的特点,评价TCS患儿盆底神经肌肉损伤的程度.方法 2008年5月至2010年12月对88例TCS患儿组和26例正常患儿行双侧肛提肌、耻骨直肠肌和肛门外括约肌肌电图检查,以及阴部神经运动传导和阴部神经体感诱发电位(PN-SSEP)检查.结果正常对照组患儿肛提肌、肛门外括约肌和耻骨直肠肌在静息状态时均可见持续收缩动作电位,大力收缩动作电位密集,呈干扰相.患儿组盆底肌肌电图(pelvic floor muscles electromyographic,PFM-EMG)表现为不同程度的神经源性损害,甚至呈现完全失神经支配,肛提肌较肛门外括约肌病变严重.患儿组阴部神经运动传导波幅降低,潜伏期延长,其中15例患儿出现双侧不对称.阴部神经体感诱发电位潜伏期延长,甚至波形消失.结论盆底神经电生理学检测对了解TCS盆底神经肌肉损害程度,评价大小便功能,估计预后具有重要意义.
목적 이용신경전생리검측기술분석척수전계종합정(tethered cord syndrome,TCS)환인분저신경화기육공능개변적특점,평개TCS환인분저신경기육손상적정도.방법 2008년5월지2010년12월대88례TCS환인조화26례정상환인행쌍측항제기、치골직장기화항문외괄약기기전도검사,이급음부신경운동전도화음부신경체감유발전위(PN-SSEP)검사.결과 정상대조조환인항제기、항문외괄약기화치골직장기재정식상태시균가견지속수축동작전위,대력수축동작전위밀집,정간우상.환인조분저기기전도(pelvic floor muscles electromyographic,PFM-EMG)표현위불동정도적신경원성손해,심지정현완전실신경지배,항제기교항문외괄약기병변엄중.환인조음부신경운동전도파폭강저,잠복기연장,기중15례환인출현쌍측불대칭.음부신경체감유발전위잠복기연장,심지파형소실.결론 분저신경전생이학검측대료해TCS분저신경기육손해정도,평개대소편공능,고계예후구유중요의의.
Objective We aim to analyze the electrophysiological characteristics of pelvic floor musculature of the patients with tethered cord syndrome(TCS),and to evaluate the extent of pelvic floor neuromuscular injury.Methods 88 Patients with tethered cord syndrome and 26 normal children had electromyography of levator ani,puborectalis and external anal sphincter performed.Pudendalmotor nerve conduction,as well as pudendal nerve somatosensory evoked potential study(PN-SSEP) were carried out from May,2008 to December,2010.Results Levator ani,external anal sphincter and puborectalis all had tonic activity in normal children at rest.During maximum voluntary contraction,action potential was seenas an increase of the firing frequency of these motor units,and recruitment of motor units was of interference pattern(IP).In patients suffering from TCS,PFM-EMG indicated different degrees of neurogenic damage,even to the degree of total denervation.The amplitude of pudendal nerve motor conduction decreased and latency prolonged in TCS group,together with delayed cortical potential latency(P41),and increased stimulation threshold.Conclusions The electrophysiological study of pelvic floor muscles could help us understand the degree of neuromuscular damage in patients with TCS,and further evaluate urinary and fecal function and prognosis.