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【目的】分析应用神经电生理技术对单纯痉挛型脑瘫患儿进行选择性后根阻断术(selective posterior rhi-zotomy,SPR)中的神经保护作用。【方法】对18例单纯痉挛型脑瘫选择性后根切除时,术中运用体感诱发电位(SEP)监测+肌源性运动诱发电位(MMEP)指导选择被阻断的神经后根,设定监护标准,记录术中变化,并对神经功能进行术前、术后比较。【结果】18例采用诱发电位监护患儿中,13例术前有不同程度的运动及感觉诱发电位改变,5例有周围运动诱发电位改变,体感诱发电位正常;术中10例手术全过程SEP平稳,术后未出现新的神经系统症状;5例麻醉后MMEP有波出现但不稳定,术后出现大小便异常,两周内恢复;3例在手术操作中出现SEP报警,其中1例经术者暂缓、暂停操作,查找原因,待波形恢复后继续手术,术后未出现新的神经损伤症状。【结论】SPR术中运用SEP+MMEP监测指导,能客观、准确、最大限度地保留脊髓及脊神经功能,避免新的神经损伤尤其是圆锥、马尾神经损伤。
【Objective】 To analyze the neuroprotective effect of selective posterior rhi-zotomy (SPR) in children with spastic cerebral palsy treated by electrophysiology. 【Methods】 Selective posterior rhizotomy was performed in 18 patients with simple spastic cerebral palsy. During the operation, somatosensory evoked potentials (SEP) monitoring and myogenic motor evoked potential (MMEP) were used to guide the selection of the blocked posterior nerve roots. Standard, record changes in surgery, and neurological function preoperative and postoperative comparison. 【Results】 Among the 18 children with evoked potentials, 13 had varying degrees of motor and sensory evoked potentials before surgery, 5 had peripheral motor evoked potentials and normal somatosensory evoked potentials. During the operation, SEP 5 cases showed wave but not steady after operation, abnormal urine and urine appeared after operation, recovered within 2 weeks; 3 cases showed SEP alarm during operation, of which 1 case had menstrual cycle The surgeon suspended, suspended operation, find out the reason to be resume operation after the waveform recovery, no new symptoms of nerve injury after surgery. 【Conclusion】 The guidance of SEP + MMEP monitoring during SPR can objectively and accurately preserve the functions of the spinal cord and spinal nerves to avoid new nerve injury, especially conus and cauda equina injury.