1037例痉挛性脑瘫显微神经外科手术治疗

Microneurosurgical treatment for relief of spasticity of cerebral palsy patients (with 1 037 cases)

目的 探讨显微神经外科手术治疗痉挛性脑瘫的疗效。方法 回顾分析2000年3月至2004年3月的显微神经外科手术治疗1 037例痉挛性脑瘫病例。依据病例的不同情况采用相应的选择性周围神经部分切断术,包括:胫神经、坐骨神经、肌皮神经、正中神经、尺神经、颈段和腰骶段脊神经后根。结果 全部患者平均随访24. 1个月。96. 05%患者术后即感痉挛状态缓解,随访期间缓解率为91. 23%。术后6周内运动功能改善率为70. 74%,随访期间为87. 24%。生活质量提高率在随访期间为89%。术后发生肢体感觉障碍382侧(21. 66% ),肌无力256侧(14. 51% ),随访期间均见好转。术后肢体痉挛状态不同程度复发134例(10. 58% )。结论 选择性周围神经部分切断术是治疗痉挛性脑瘫安全有效的手术方法。选择合适的病例、熟悉局部解剖、掌握显微手术技巧和术后坚持长期正规康复训练是保证疗效的关键。

Objective To study the effectiveness of microneurosurgical treatment for relief of spasticity in cerebral palsy patients.Methods A total of 1 037 cases of cerebral palsy patients with spasticity of limbs was treated by microsurgical selective peripheral neurotomy from March, 2000 to March, 2004. The peripheral nerves included tibial, sciatic, musculocutaneous, median, ulner, cervical and lumbosacral spinal nerves.Results At follow-up evaluation (mean duration of 24.1 months), this study showed that 96.05% of cases experienced disappearance or notable regression of the spasticity right after operation, and the relief percentage in follow-up duration was 87.24%. The improved motor capacities within 6 weeks after operation were found in 70.74% of cases, while 87.24% in follow-up duration. Improved ratio of quality of life was 89% by follow-up studying. Postoperative complications included dysasthesias of limbs in 382 cases (21.66%), and muscle weakness in 256 cases (14.51%). Recurrence of spasticity was found in 134 cases (10.58%) .Conclusion Selective peripheral neurotomy is an effective and safe microsurgical method for the treatment of spasticity of limbs in cerebral palsy patients. The proper choice of cases, understanding of regional anatomy, microsurgical techniques and postoperative rehabilitation are keys to gain good effects.