CAJ | 학술논문

目的评估神经电生理监测在二次改良Foerster-Dandy手术治疗痉挛性斜颈围手术期中的应用.方法回顾性纳入40例采用二次改良Foerster-Dandy手术治疗的重型痉挛性斜颈患者.术中行脊神经前、后根直接电刺激,根据肌电图(EMG)结果选择神经根切断的比例.术中行体感诱发电位(SEP)监测脊髓传导通路功能的完整性.根据手术前后胸锁乳突肌、斜方肌、头夹肌的EMG结果判定疗效.结果 EMG显示,术后胸锁乳突肌、斜方肌、头夹肌的转折数、波幅均较术前的比值下降(P＜0.01),胸锁乳突肌下降程度更明显;胸锁乳突肌的转折数与波幅的比值较术前下降(P＜0.01),斜方肌、头夹肌该比值变化不明显.根据术中监测结果,双侧副神经切断的比例为100％,C1前根为80％～ 90％,C2前根60％～ 75％,C2后根10％～15％,C3前根45％～60％,C3后根50％～70％.2例患者术中SEP波幅及潜伏期较预警基准电位下降,经调整手术操作方式或停止操作后恢复,术后均无脊髓功能损害表现.随访0.5 ～2.5年,随访期间缓解率为92.5％ (37/40),3例痉挛状态不同程度复发.结论手术前后同一痉挛责任肌肉EMG相关参数的差异可客观地评估手术疗效;术中电生理监测量化了神经切断的比例,可避免神经损伤;术中SEP监测能有效地减少高位颈髓损伤的可能.
목적 평고신경전생리감측재이차개량Foerster-Dandy수술치료경련성사경위수술기중적응용.방법 회고성납입40례채용이차개량Foerster-Dandy수술치료적중형경련성사경환자.술중행척신경전、후근직접전자격,근거기전도(EMG)결과선택신경근절단적비례.술중행체감유발전위(SEP)감측척수전도통로공능적완정성.근거수술전후흉쇄유돌기、사방기、두협기적EMG결과판정료효.결과 EMG현시,술후흉쇄유돌기、사방기、두협기적전절수、파폭균교술전적비치하강(P＜0.01),흉쇄유돌기하강정도경명현;흉쇄유돌기적전절수여파폭적비치교술전하강(P＜0.01),사방기、두협기해비치변화불명현.근거술중감측결과,쌍측부신경절단적비례위100％,C1전근위80％～ 90％,C2전근60％～ 75％,C2후근10％～15％,C3전근45％～60％,C3후근50％～70％.2례환자술중SEP파폭급잠복기교예경기준전위하강,경조정수술조작방식혹정지조작후회복,술후균무척수공능손해표현.수방0.5 ～2.5년,수방기간완해솔위92.5％ (37/40),3례경련상태불동정도복발.결론 수술전후동일경련책임기육EMG상관삼수적차이가객관지평고수술료효;술중전생리감측양화료신경절단적비례,가피면신경손상;술중SEP감측능유효지감소고위경수손상적가능.
Objective To evaluate the application of neurophysiological monitoring in the second modified Foerster-Dandy's operation for the treatment of spasmodic torticollis during perioperative period.Methods Forty patients with severe spasmodic torticollis treated with the second modified Foerster-Dandy's operation were enrolled retrospectively.Direct electrical stimulation of anterior and posterior roots of spinal nerves was performed during the operation.The proportion of rhizotomy was selected according to the results of electromyography (EMG).Intraoperative somatosensory evoked potential (SEP) was used to monitor the integrity of spinal transduction pathway function.The efficacy was determined according to the EMG results of sternocleidomastoid,trapezius,and splenius capitis before and after surgery.Results EMG showed that the turning numbers and amplitudes of sternocleidomastoid,trapezius,and splenius capitis after surgery were decreased compared with before surgery (P ＜ 0.01).The decreased degree of sternocleidomastoid was more significantly;the ratios of the turning number and amplitude of sternocleidomastoid were decreased (P ＜ 0.01),whereas the ratios of trapezius and splenius capitis did not change obviously.According to the results of intraoperative monitoring,the proportion of bilateral accessory neurectomy was 100％,anterior roots of C1 was 80％-90％,anterior roots of C2 was 60％-75％,posterior roots of C2 was 10％-15％,anterior roots of C3 was 45％-60％,and posterior roots of C3 was 50％-70％.The intraoporative SEP amplitude and latency in 2 patients were decreased compared with the warning reference potential.They recovered after adjusting surgical operation mode or stopping operation.No postoperative spinal cord function injury was observed.The patients were followed up for 0.5-2.5 years.The remission rate was 92.5％ (37/40) during follow-up period.The spasticity recurred in varying degrees in 3 cases.Condlusions The differences of EMG related parameters of the same spastic guilty muscle before and after surgery may objectively assess the efficacy of surgery.The intraoperative electrophysiological monitoring quantifies the proportion of neurectomy and avoids nerve injury.The intraoperative SEP monitoring may effectively reduce the possibility of high cervical cord injury.