CAJ | 학술논문

目的探讨SPR术引起患者双下肢感觉功能异常的相关机制及临床意义. 方法从2012年2月至2014年8月,共收治拟行SPR术的痉挛性脑瘫24例,检测手术前、手术后1周双下肢皮肤的触觉、浅痛觉、温度觉、运动觉、位置觉、振动觉、深痛觉、触觉定位觉、两点辨别觉及图案觉. 结果术后出现自觉双下肢麻木共6例,发生率为25％.其中,4例于手术后2周内自行缓解,1例于术后3周左右症状消失,1例持续6周后症状消失,未发现有永久性感觉丧失及麻木的患者.出现与未出现双下肢麻木的症状患者SPR术中脊神经后根平均切除比例分别为0.268±0.049、0.193±0.074,差异有统计学意义(P＜0.05).患者双下肢的触觉、运动觉、位置觉、深痛觉、触觉定位觉、两点辨别觉、振动觉手术前、手术后1周的差异均无统计学意义(P＞0.05).浅痛觉、温度觉、图案觉术后1周较术前有轻度减弱. 结论 SPR术对下肢感觉功能的轻度损害不会影响患者机体的保护性感觉功能.术后出现下肢麻木症状的可能性与后根的切除比例有关,未发现与年龄有关.SPR术引起患者下肢感觉功能的损害症状可于术后2～6周内自然恢复.从下肢感觉功能检测发现SPR术安全可靠.
목적 탐토SPR술인기환자쌍하지감각공능이상적상관궤제급림상의의. 방법 종2012년2월지2014년8월,공수치의행SPR술적경련성뇌탄24례,검측수술전、수술후1주쌍하지피부적촉각、천통각、온도각、운동각、위치각、진동각、심통각、촉각정위각、량점변별각급도안각. 결과 술후출현자각쌍하지마목공6례,발생솔위25％.기중,4례우수술후2주내자행완해,1례우술후3주좌우증상소실,1례지속6주후증상소실,미발현유영구성감각상실급마목적환자.출현여미출현쌍하지마목적증상환자SPR술중척신경후근평균절제비례분별위0.268±0.049、0.193±0.074,차이유통계학의의(P＜0.05).환자쌍하지적촉각、운동각、위치각、심통각、촉각정위각、량점변별각、진동각수술전、수술후1주적차이균무통계학의의(P＞0.05).천통각、온도각、도안각술후1주교술전유경도감약. 결론 SPR술대하지감각공능적경도손해불회영향환자궤체적보호성감각공능.술후출현하지마목증상적가능성여후근적절제비례유관,미발현여년령유관.SPR술인기환자하지감각공능적손해증상가우술후2～6주내자연회복.종하지감각공능검측발현SPR술안전가고.
Objective To explore the reason why the SPR could make the changes of Sensory Function of Lower extremities,and the clinical significance of these changes.Methods From February,2012 to August,2014,24 patients with spastic cerebral palsy who were consistent with the indications of SPR,had normal intelligence development,and express competence,and could cooperate with the test.To test the changes of Sensory Function of lower extremities preoperatively,1 week after SPR,such as haptics,superficial algaesthesis,temperature sensation,cinaesthesia,topesthesia,pallesthesia,deep pain sense,tactile localization sense,two point discrimination and pattern sense.Results There were 6 patients who present with skin paresthesia of lower extremities among the 24 patients after the SPR.Of the 6 patients,4 became normal 2 weeks later,1 became normal 3 weeks later,and the longest 1 became normal 6 weeks later.No instances with permanent sensory deprivation and anaesthesia were found.The proportions of the excised root of spinal nerves during the SPR in the groups with skin anaesthesia of lower extremities and without skin anaesthesia of lower extremities were 0.268 ± 0.049 and 0.193 ± 0.074 (P ＜ 0.05 respectively).The former was significantly higher than the latter.The changes of haptics,cinaesthesia,topesthesia,deep pain sense,tactile localization sense,two point discrimination,pallesthesia preoperatively,1 week after SPR were not significantly different (P ＞ 0.05).There were significant differences in the superficial algaesthesis,pattern sense and temperature sensation preoperatively and postoperatively (P ＜ 0.05).Both of them decreased compared with those of 1 week after SPR.Conclusion The slight damage to sensory function of lower extremities resulted from SPR may not affect the protectant sensory function of the body.The skin anaesthesia of lower extremities is probably concerned with the proportion of the excised root of spinal nerves during the SPR,but not associated with the age.The impaired symptoms of the sensory function of lower extremities resulted from SPR can spontaneous recover in 2-6 weeks after SPR.SPR is safely with the clinic research on the sensory function of lower extremities.