CAJ | 학술논문

目的：探讨在周围神经选切治疗痉挛性脑瘫中阈值的意义。方法：41例痉挛性脑瘫，16例SPR和8例SAR术中电刺激脊神经前后根神经小束，28例经皮刺激坐骨神经，观察相应肌肉运动诱发反应，25例取周围神经标本40个，进行透射电镜观察。结果：电刺激神经小束或坐骨神经诱发的肌肉收缩反应或M波幅，存在着最大、最小现象。当达到最大后，保持稳定，不再随刺激强度增大而增加。周围神经呈原发性脱髓鞘病变，有髓纤维病变明显于无髓纤维，粗纤维重于细纤维。结论：在周围神经选切治疗痉挛性脑瘫中，阈值作为判断所切神经小束中能够基本正常发挥有髓纤维传导功能的纤维含量，存在着一定的可行性。
목적：탐토재주위신경선절치료경련성뇌탄중역치적의의。방법：41례경련성뇌탄，16례SPR화8례SAR술중전자격척신경전후근신경소속，28례경피자격좌골신경，관찰상응기육운동유발반응，25례취주위신경표본40개，진행투사전경관찰。결과：전자격신경소속혹좌골신경유발적기육수축반응혹M파폭，존재착최대、최소현상。당체도최대후，보지은정，불재수자격강도증대이증가。주위신경정원발성탈수초병변，유수섬유병변명현우무수섬유，조섬유중우세섬유。결론：재주위신경선절치료경련성뇌탄중，역치작위판단소절신경소속중능구기본정상발휘유수섬유전도공능적섬유함량，존재착일정적가행성。
Objective:To investigate the clinical significance of threshold of rootlet in treatment of spastic cerebral palsy by selective peripheral neurotomy. Methods:Of 41 patients , 16 underwent selective posterior rhizotomy and 8 underwent selective anterior rhizotomy. Those nerve rootlets were stimulated by a single stimulus, the muscular responses in the segmental distribution of the rootlet were observed.The features of motor evoked responses in gastrocnemius muscle were observed in 28 patients by percutaneous sciatic nerve stimulation. 40 peripheral nerve specimens of 25 patients with spastic cerebral palsy were observed under electron microscope.Results:Those evoked response, stimulated posterior rootlet , anterior rootlet and sciatic nerve , showed minimal and maximal appearance.The maximal response did not increase with the increasing stimulus intensity．The damage of primary demyelination was extensive on the peripheral nerves and the pathological changes of myelinated nerve fibers were more obvious than the nonmyelinated nerve fibers.Conclusion:It is feasible that using threshold of nerve rootlet identify the number of motorial reflex circuit in the rootlet.