混合型脑性瘫痪的手术指征和手术方法选择

Operation indications and choice of operation methods of mixed cerebral palsy

目的:通过观察选择性脊神经后根切断术(selectiveposteriorrhizotomy,SPR)合并选择性脊神经前根切断术(selectiveanteriorrhizotomy,SAR)对混合型脑性瘫痪的治疗效果,探讨混合型脑性瘫痪的手术指征和手术方法。方法:62例混合型脑性瘫痪患儿,随机分成2组,SPR+SAR组在施行SPR的基础上合并施行SAR,SPR组单纯施行SPR,评价两组的疗效。结果:SPR+SAR组和SPR组手术后肌张力的分级为1.19±0.22和1.24±0.20,均较手术前(3.33±0.42和3.35±0.38)提高,差异有显著性意义(t=20.587,19.537;P<0.001);痉挛程度的缓解情况两组差异无显著性意义(χ2=0.044,P>0.05);SPR+SAR组手足徐动症状的改善情况优于SAR组。结论:以痉挛为主伴有手足徐动是混合型脑性瘫痪的手术指征,SPR和SAR结合是不但能够有效的解除肢体痉挛,而且能在一定程度上控制手足徐动。

AIM:To explore the operation indications and operation methods of mixed cerebral palsy by observing the curative effects of combined use of selective posterior rhizotomy(SPR) and selective anterior rhizotomy (SAR). METHODS:Sixty two children with mixed cerebral palsy were randomly divided into two groups:SPR +SAR group and SPR group,and curative effects were evaluated in both groups. RESULTS:The muscle tones in the SPR+SAR group and SPR group after operation were 1.19±0.22 and 1.24±0.20,significantly higher than those before operation(3.33±0.42 and 3.35±0.38)(t=20.587,19.537,P< 0.001);there was no obvious difference in the alleviation of spasm between the two groups (χ2=0.044,P >0.05);the improvement of athetoid in the SPR +SAR group was superior to that in the SPR group. CONCLUSION:Spastic symptoms along with athetoid are the operation indications of mixed cerebral palsy.The combined use of SPR and SAR cannot only relieve body spasm but also control athetoid to a certain extent.