探讨在肌电监测下周围神经缩窄术治疗痉挛型脑瘫的临床效果。

纳入航空总医院神经外科自2018年1月至2020年6月行周围神经缩窄手术的65例痉挛型脑瘫患者。术前采用表面肌电（sEMG）及改良Ashworth量表（MAS）肌张力分级标准对目标痉挛肌群评定分级，术中给予目标肌群的痉挛肌肉神经分支分别缩窄。应用sEMG、MAS分级、运动学参数（步速、步频、步长、步宽、足夹角）、日常生活能力量表（ADL）评分、简式Fugl-Meyer运动功能评分法量表评估患者生活能力及运动功能。

65例痉挛性脑瘫患者共缩窄周围神经193束，围术期肌张力下降比例为100%，术后肌张力达到正常比例为92.75%，术前及术后7 d sEMG比较差异有统计学意义（P<0.05）。与术前比较，围术期步行功能、中远期日常生活能力及运动功能明显改善，差异有统计学意义（P<0.05）。股神经缩窄术股四头肌围术期肌力下降发生率为16.67%（2/12），随访期间肌力恢复。

周围神经缩窄术治疗痉挛型脑瘫，术前采用sEMG确定目标肌群，术中通过肌电监测及刺激肌电数据量化指导，显微镜下给予目标肌群中痉挛肌肉的神经分支行缩窄手术是降低肌张力的有效外科治疗方法，对提高痉挛型脑瘫患者步行、运动能力及日常生活能力作用明显。

To investigate the clinical effect of selected-peripheral-neurotomy under electromyography monitoring in the treatment of spastic cerebral palsy.

Sixty five patients with spastic cerebral palsy who underwent selected-peripheral-neurotomy surgery in Department of Neurosurgery of Aviation General Hospital from January 2018 to June 2020 were included. Surface electromyography (sEMG) and modified Ashworth scale (MAS) were used to evaluate the target spastic muscle group before operation. The nerve branches of target spastic muscle group were narrowed during operation. sEMG, MAS grading, kinematic parameters (walking speed, frequency, step length, step width, foot angle), ADL score and Fugl-Meyer motor function score were used to evaluate the patients’ living ability and motor function.

A total of 193 peripheral nerve tracts were constricted in 65 patients with spastic cerebral palsy. The decrease rate of muscle tension was 100% in perioperative period and the normal rate of muscle tension was 92.75% in postoperative period. There was significant difference in SEMG before and 7 d after operation (P<0.05). Compared with preoperative, walking function, activities of daily living and motor function were significantly improved in perioperative period (P<0.05). The incidence of decreased muscle strength of quadriceps femoris during perioperative period was 16.67% (2/12). Muscle strength recovered during follow-up.

Selected-peripheral-neurotomy constriction was used to treat spastic cerebral palsy. Before operation, sEMG was used to determine the target muscle group. During operation, electromyography monitoring and stimulating electromyography data quantitative guidance were used. The nerve branches of the spastic muscles in the target muscle group were given narrowing operation under the microscope. These were effective surgical methods to reduce muscle tension, and had obvious effect on improving walking, motor ability and activities of daily living of patients with spastic cerebral palsy.