颈交感神经节后纤维束切断治疗痉挛性瘫痪

Treatment for spastic palsy with superior cervical sympathectomy

目的:因颈部交感神经节切断后氧摄取量增加情况下能选择性改善脑皮质区域的氧供,故探讨颈上交感神经切断对痉挛性瘫痪的治疗效果。方法:选择南溪山医院神经外科收治的52例脑卒中后(包括多发性腔隙性脑梗死)伴痉挛性瘫痪或肌张力增高者、病程超过3个月、无重大心肝肺肾疾病、头颅CT扫描低密度改变的痉挛性瘫痪患者进行颈上交感受神经纤维切断术,术后观察患者的神经症状、肌力及肌张力改变等康复情况。结果:颈上交感受神经纤维切断后,患者肢体痉挛症状改善,50例(50/52)患者的肌张力有不同程度不同下降,43例(43/52)患者的肌力有不同程度提高,综合康复有效率为87%(47/52)。经t检验,术前术后肌力比较差异有显著性意义(P<0.05)。结论:颈上交感受神经纤维切断,能不同程度缓解患者痉挛状态,对痉挛性瘫痪有一定的治疗效果。

AIM:The increase of oxygen intake after superior cervical sympathectomy can selectively improve the oxygen supply in the cortex of brain,so the aim of this study was to explore the curative effect of cervical sympathectomy on spastic palsy.METHODS:A total of 52 stroke patients(including multiple lacunar cerebral infarction),selected from the Department of Neurosurgery,Nanxishan Hospital,received superior cervical sympathectomy.All the patients were complicated by spastic palsy or hypermyotonia,with disease course over 3 months,without severe diseases of heart,liver,lung and kidney,and had cranial CT scanning low density changes. The changes of neurological symptoms,muscle strength and muscular tension on limbs of the patients was detected after cervical sympathectomy. RESULTS:After superior cervical sympathectomy,spasm of limbs was improved,the muscular tension of 50 cases(50/52) decreased,but the muscle strength of 43 cases(43/52) increased to different degrees,and the effective rate of general rehabilitation was 87.4%(47/52).The t test showed that significant difference of muscle strength was observed before and after superior cervical sympathectomy. CONCLUSION:Muscle spasm on limbs of patients is improved after superior cervical sympathectomy to different degree,which has certain curative effect on spastic palsy.