选择性脊神经后根切断术结合下肢矫形术治疗痉挛性脑性瘫痪

Treatment of spastic cerebral palsy by selective posterior rhizotomy combined with orthopaedic operation of lower extremities

目的:观察对伴有下肢畸形的痉挛性脑性瘫痪者行选择性脊神经后根切断术(selectiveposteriorrhizotomy,SPR)和组合式下肢矫形术的疗效分析,探索治疗痉挛性脑瘫的有效途径。方法:1996-02/2002-05,对40例伴有下肢畸形的痉挛性脑瘫患者,男22例,女18例,年龄4岁～17岁,行SPR降低肌张力,缓解肌痉挛,矫正部分下肢畸形,再行组合式下肢矫形术矫正残余畸形,配合系统的功能康复训练。平均随访4.2年(2年～7.5年),采用刘小林等的脑瘫疗效评估标准,比较SPR术前和术后、SPR术前和下肢矫形术后脑瘫分项功能评分和脑瘫痉挛临床分项评估。结果:在SPR术后,脑瘫对比分项中躯干活动和蹲立变换两项恢复率分别为88%和72%,差异有显著性意义(P<0.05)。采用SPR和组合式下肢矫形术系统治疗后,脑瘫对比分项的各项恢复率均在90%以上,脑瘫痉挛临床分项各项的改善率均为80%以上,尤其尖足现象和交腿现象的改善率为100%;下肢肌张力由平均4.2级降至平均1.4级。结论:选择性脊神经后根切断结合下肢矫形术及功能康复训练是治疗伴有下肢畸形的痉挛性脑瘫的有效途径。

AIM:To study an effective therapy for spastic cerebral palsy(CP) with deformity of lower extremities by analyzing the efficacy of treatment of selective posterior rhizotomy(SPR) and composite orthomorphia of lower extremities in spastic CP patients accompanied with deformed lower extremities. METHODS:Forty spastic CP patients accompanied with deformed lower extremities(22 males and 18 females,aged 4 to 17 years old),received SPR,which could decrease muscular tension and relieve muscular spasm,correction of part deformed lower extremities and composite orthomorphia of lower extremities,which could correct other remanent deformations,besides,systematic functional rehabilitation training was also applied. They were averagely followed-up for with 4.2 years(2 to 7.5 years).The scores of respective functions of CP and the evaluation of respective clinical spasm of CP were compared between before and after SPR,between before SPR and after orthomorphia of lower extremities with the criterion of evaluation for efficacy of CP which was composed by Liu XL et al.RESULTS:After SPR,the recovery rates of body activity and variation between squatting and standing positions among the CP comparative items were 88%and 72%with significant difference(P< 0.05).After the systematic treatments of SPR and composite orthomorphia of lower extremities,the recovery rates of all the CP comparative items were over 90%,and the ameliorating rates of the CP clinical spasm items were all over 80%,especially those for pointed feet and legs exchanging were 100%.The muscle tension of lower extremities was averagely decreased from 4.2 scales to 1.4 scales. CONCLUSION:SPR combined with orthomorphia of lower extremities is a reasonable and effective therapy for the spastic CP patients with deformity of lower extremities.