1244例痉挛状态的显微神经外科手术治疗

Microneurosurgical treatment for relief of spasticity ( 1244 Cases)

目的探讨显微神经外科手术治疗痉挛状态的疗效。方法回顾分析2000年3月至2004年5月实施的1244例显微神经外科手术治疗痉挛状态,根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、副神经、颈段和腰骶段脊神经前、后根。结果全部患者平均随访24.3个月。96.26%患者术后立即感痉挛状态缓解,随访期间缓解率为90.68%。术后6周内运动功能改善率为71.63%,随访期间为86.72%。生活质量提高率在随访期间为88.67%。术后发生肢体感觉障碍478侧(23.17%),肌无力378侧(18.32%),随访期间均见好转。术后痉挛状态不同程度复发165例(10.83%)。结论选择性周围神经部分切断术是治疗痉挛状态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. Methods 1244 cases of spasticity patients were treated by microsurgical selective peripheral neurotomy from March 2000 to May 2004. The peripheral nerves included： tibial, sciatic, musculocutaneous, median, ulner, accessory, cervical and lumbosacral spinal nerves. Results At follow up evaluation （mean duration ： 24. 3 months ）, this study showed that 96. 26% cases experienced disappearance or notable regression of the spasticity right after operation, and the percentage in follow-up duration was 90.68% . The improved motor capacities within 6 weeks after operation were found in 71.63% cases, while 86.72% in follow-up duration. 88.67% cases had better quality of life by follow-up studying. Postoperative complication included dysaesthesias of limbs in 478 limbs （23.17%） , muscle weakness in 378 （ 18.32% ）. There were 165 cases （ 10. 83% ） of recurrence of spasticity. Conclusion Selective peripheral neurotomy is an effective and safe microsurgical method for the treatment of spasticity . The proper choice of cases, understanding of regional anatomy, microsurgical techniques and postoperative rehabilitation are keys to gain good effects.