圆锥水平选择性脊神经后根切断术治疗痉挛型脑瘫

Selective posterior rhizotomy of L_2-S_1 posterior roots at medullary conus for spasticity with cerebral palsy

目的探讨在脊髓圆锥水平施行L2～S1选择性脊神经后根切断术(selective posterior rhizotomy,SPR)治疗痉挛型脑瘫(cerebralpalsy,CP)的临床价值。方法2002年5月～2005年12月,我们在圆锥水平施行SPR治疗63例痉挛型CP。术前和术后不同时间按照Ashworth痉挛评分法对下肢肌肉不同肌群的痉挛情况进行评分。结果术后下肢痉挛状态均明显缓解,术后2周、3个月和6个月的Ashworth痉挛评分与术前比较均有显著性差异(P<0.01)。除暂时性下肢麻木、乏力外,未出现括约肌功能障碍等严重并发症。结论在圆锥水平施行SPR具有创伤小、恢复快、操作简便、疗效确切等优点,能够有效缓解痉挛型CP病人的下肢肌肉痉挛。

Objective To study clinical application of selective posterior rhizotomy （SPR） of L2-S1 at medullary conus level for treatment of cerebral palsy （CP）. Methods Sixty-three patients with spastic CP were treated with SPR at medullary conus level from May 2002 to December 2005. Ashworth scale was used for preoperative and postoperative evaluation of the spastic degree of lower limb muscles. Results Postoperatively, all the patients presented with improvement of motor function in the lower limbs and reduction of spasticity in all the muscle groups. The postoperative Ashworth scale （2 weeks, 3 and 6 months） was statistically significant compared with the preoperative scale （P 〈 0.01）. Postoperative complications included transient numbness and debilitation of lower limbs. There was no serious complication of sphincter functional disorder. Conclusion We conclude that SPR at medullary conus is of such advantages as small wound, rapid recovery, simple operation and certain therapeutic efficacy, and could alleviate spasticity of the lower limbs in the patients with spastic CP.