选择性正中神经分支部分切断术治疗脑瘫性腕、指痉挛

Selective Median Neurotomy for Relief of Spasticity Focalized to Wrists and to Fingers in Children with Cerebral Palsy

目的探讨选择性正中神经分支部分切断术治疗脑瘫患儿腕、指部痉挛状态的治疗效果。方法回顾分析2000年3月至2004年3月显微手术治疗的57例脑瘫患儿77侧腕、指部痉挛状态病例。全部病例采用选择性正中神经分支部分切断术治疗。结果全部病人平均随访25个月。100%病人术后立即感腕、指部痉挛状态缓解,随访期间缓解率为88.31%(68/77)。术后6周内运动功能改善率为90.91%(70/77),随访期间为74.03%(57/77)。生活质量提高率在随访期间为89.47%(51/57)。术后发生上肢感觉障碍37侧,肌无力26侧,随访期间均见好转。随访期间痉挛状态复发10侧(12.99%)。结论选择性正中神经分支部分切断术治疗脑瘫患儿腕、指部痉挛状态是安全有效的。

Objective To study the curative effect of selective median neurotomy on spasticity focalized to the wrists and to the fingers in children with cerebral palsy. Methods Seventy-seven sides of wrists and fingers involved in spasticity were treated by microsurgical selective median neurotomy from March 2000 to March 2004 in 57 children with cerebral palsy. All the patients were averagely followed up for 25 months. Their clinical data were analyzed retrospectively. Results All the patients experienced disappearance or notable relief of the spasticity immediately after the operation. The rate of relieving spasticity was 88.31% （68/77） during the follow-up. The improved motor functions were found in 90.91% upper limbs （70/77） six weeks after the operation and in 74.03% （57/77） upper libms during the follow-up. There were better quality of life in 89.47%（51/57） of the patients during the follow-up. The postoperative complications included the dysesthesia in 37 upper limbs （48.05 %, 37/77）,muscle weakness in 26（33.77 %, 26/77） and recurrence of spasticity in 10 limbs（12.99%, 10/77）. Conclusions The selective median neurotomy is an effective and safe method for the treatment of wrists and fingers spasticity in children with cerebral palsy.