Lazareff J A, Valencia Mayoral P F
Departamento de Cirugia Experimental, Hospital Infantil de Mexico.
Acta Neurochir (Wien). 1990;105(1-2):35-8. doi: 10.1007/BF01664855.
During selective posterior rhizotomy, for the treatment of spasticity in infantile cerebral palsy, the rootlets to be divided are chosen by the type of electromyographic response elicited by intraoperative electrical stimulation. Two different surgical techniques were used for exposing the lumbar roots. The first approach was to expose the conus medullaris through a T 12-L 1 laminectomy, while the other approach to the dorsal roots was distally in the cauda equina through a L 2-L 3 to S1 laminectomy. Although the clinical results obtained with either of them are not very different, there is anatomical evidence that suggests that the histological structure of the divided rootlets may be different in the two techniques. We designed our study to determine of a significant difference in the number of large myelinated fibers was found between rootlets divided close to the conus medullaris and those divided distally in the cauda equina. Two groups of five children with spasticity secondary to cerebral palsy where randomly designed to be operated upon by one of the techniques. The divided rootlets were processed with standard histological techniques and the large myelinated fibers were counted on enlarged (40 x) photomicrograph of the rootlet. A significantly (p less than 0.001) larger number of large myelinated axons was found in the rootlets dissected and divided close to the conus medullaris.
在选择性后根切断术中，为治疗婴儿脑瘫的痉挛，通过术中电刺激引发的肌电图反应类型来选择要切断的神经根丝。采用两种不同的手术技术暴露腰神经根。第一种方法是通过T12 - L1椎板切除术暴露脊髓圆锥，而另一种暴露背根的方法是通过L2 - L3至S1椎板切除术在马尾神经远端进行。尽管两种方法获得的临床结果差异不大，但有解剖学证据表明，两种技术中切断的神经根丝的组织结构可能不同。我们设计本研究以确定在靠近脊髓圆锥切断的神经根丝与在马尾神经远端切断的神经根丝之间，大的有髓纤维数量是否存在显著差异。两组各五名患有脑瘫继发性痉挛的儿童被随机分配接受其中一种技术的手术。将切断的神经根丝用标准组织学技术处理，并在神经根丝放大（40倍）的显微照片上计数大的有髓纤维。结果发现，在靠近脊髓圆锥处切断并分离的神经根丝中，大的有髓轴突数量显著更多（p小于0.001）。
