肛门括约肌肌电图监测下双侧L2～S2选择性脊神经后根切断术治疗痉挛性脑瘫

目的为提高手术安全性,在L2～S2选择性脊神经后根切断(SPR)手术时,对肛门括约肌进行肌电图(EMG)监测,并评价其作用。方法在SPR手术监测中,当对S2后根小束进行电刺激时,采用针状电极记录双侧肛门括约肌的反应情况,有明显反应的后根小束予以保留。手术后随访患者踝痉挛改善情况和括约肌功能变化情况。结果所有患者手术后踝痉挛均有明显改善,无大小便功能障碍发生。结论SPR手术包括S2后根时,术中括约肌EMG监测对保证疗效,保护括约肌功能,提高手术安全,具有重要意义。

Bilateral L2 ～ S2 selective posterior rhizotomy for spastic cerebral palsy with intraoperative electromyography monitoring of anal sphincter

Objective The study is to evaluate the effect of intraoperative electromyography monitoring of anal sphincter during selective posterior rhizotomy from L2 to S2 level in order to increase the safety of procedure. Methods Each S2 rootlet was tested with electrical stimulation when S2 dorsal rootlets were involved during selective posterior rhizotomy, bilateral anal sphincter response was recorded by electromyography through needle electrode. Rootlets associated with significant sphincter response were preserved. Change of spastic ankle and sphincter function was followed up. Results All patients presented great improvement in spastic ankle after operation and no sphincter malfunction was observed. Conclusion When S2 rootlets were involved during selective posterior rhizotomy, intraoperative electromyography monitoring of anal sphincter should be used to ensure the effect, to protect the sphincter function and to increase the operation's safety.