摘要
目的:探讨选择性脊神经后根部分切断术对下肢痉挛性瘫痪患儿的治疗效果及血清转化生长因子β1(TGF-β1)、神经元特异性烯醇化酶(NSE)水平的影响。方法:52例下肢痉挛性瘫痪患儿,均行选择性脊神经后根部分切断术治疗;术前及术后2周时,采用改良Ashworth分级法评定患儿患侧下肢腘绳肌、小腿三头肌群及髋内收肌群的肌张力,采用酶联免疫吸附法检测患儿的血清TGF-β1、NSE水平,采用质子磁共振波谱分析患儿基底节区代谢产物水平,同时比较术前及术后1周时患儿的下肢浅感觉。结果:术后2周时,患儿腘绳肌、小腿三头肌群及髋内收肌群的Ashworth分级0级、Ⅰ级患儿比例较术前显著增加,Ⅲ级、Ⅳ级患儿比例均较术前显著减少(P <0. 05),患儿患侧下肢腘绳肌、小腿三头肌群及髋内收肌群的肌张力显著改善;患儿术后2周时的TGF-β1水平较术前显著升高,NSE水平较术前显著降低(P <0. 05);患儿手术前同侧、对侧及术后2周时同侧的Cho/Cr、NAA/Cr及Cho/NAA比值、术后2周时对侧的Cho/Cr比值分别比较,差异无统计学意义(P> 0. 05),对侧的NAA/Cr比值较术前显著降低、Cho/NAA比值较术前显著升高(P <0. 05);术后1周时,患儿的浅痛觉级别较术前显著上升(P <0. 05)、触觉次数及温感觉级别与术前比较,差异无统计学意义(P> 0. 05)。结论:选择性脊神经后根部分切断术治疗下肢痉挛性瘫痪患儿效果满意,可显著改善患儿腘绳肌、小腿三头肌群及髋内收肌群的张力,其机制可能与手术调节了血清TGF-β1、NSE水平及对侧基底节区代谢产物有关。
Objective:To investigate the clinical efficacy of selective posterior spinal nerve root resection onlower limbs in children and the effects on serum transforming growth factor-β1(TGF-β1)and neuron-specific enolase(NSE)levels in them.Methods:52 children with spastic paralysis of the lower extremity admitted to our hospital from October 2015 to October 2017,all patients underwent selective treatment of posterior roots of the spinal nerve.The clinical efficacy of the patients after treatment was recorded.The serum TGF-β1,NSE levels and metabolite levels in the basal ganglia were counted before and after treatment.Results:Compared with preoperative,the hamstrings,calf triceps,hip adduction muscle group of Ashworth class 0,Ⅰproportion of children patients increased significantly at 2 weeks postoperatively,Ⅲ,Ⅳproportion were significantly less than preoperative(P<0.05).The muscle tones of hamstrings,triceps and adductors of the lower limbs and legs were significantly improved.The TGF-1 level was significantly higher than that of preoperative at 2 weeks after surgery,and the NSE level was significantly lower than that before surgery(P<0.05).Cho/Cr,NAA/Cr and Cho/NAA ratios of the same side before surgery,the opposite side and the same side at 2 weeks after surgery were compared respectively,the differences were not statistically significant(P>0.05).The contralateral NAA/Cr ratio was significantly lower than that before surgery while the Cho/NAA ratio was significantly higher than that before surgery(P<0.05);compared with that before surgery,the level of superficial pain of the children increased significantly at 1 week after surgery(P<0.05);the number of tactile sensation and the level of temperature sensation were compared with those before surgery,the difference was not statistically significant(P>0.05).Conclusion:For children with lower extremity spasticity,the treatment of selective posterior root resection of the spinal nerve is satisfactory,which can significantly improve the tension of the hamstring,calf triceps and hip adductor muscles,regulate TGF-β1,NSE levels and contralateral basal ganglia metabolites.
作者
黄勇
朱安林
刘虓
陈瑞峰
宋志强
HUANG Yong;ZHU Anlin;LIU Xiao;CHEN Ruifeng;SONG Zhiqiang(Department of Neurosurgery,General Hospital of Civil Aviation,Beijing 100000,China)
出处
《贵州医科大学学报》
CAS
2019年第3期341-345,共5页
Journal of Guizhou Medical University
基金
首都卫生发展科研专项(2011-2003-03)
国家自然科学基金项目(81302304)
