选择性脊神经后根切断及软组织手术对痉挛性脑瘫的治疗

Selective Posterior Rhizotomy and Soft Tissue Operation on Spastic Cerebral Palsy

目的:探讨轻度脑瘫的治疗方法及软组织手术适应证。方法:34例随机分两组,A 组软组织手术组17例,行不同的软组织矫形术;B 组 SPR 手术组17例,行神经后根不同比例的切除术。结果:SPR 手术组术后,痉挛性症状全部消失,肌张力恢复正常,尖足行走及剪刀步消失,腱反射亢进术后1个月后消失,踝阵挛及病理反射亦全部消失。软组织手术组,痉挛性症状术后不能消失。肌张力不变,尖足行走消失,腱反射仍亢进。功能评价:所有患儿术前均不能单腿站立或站立不稳,在 SPR 手术组的17例中,术后半年能较稳定的单腿站立者10例,占58.8%,而软组织手术组17例中,术后半年能较稳定的单腿站立只有8例,占47.1%,两组患儿术后均能较稳定的在宽广场地上行走,但 SPR 组术后对躯干的控制能力较软组织手术组好。表现为行走稳定,左、右转动自如。结论:两者均能较明显的改善行走的步态,但各自不同。

Objective:To compare the results of selective posterior rhizotomy(SPR)and soft tissue operation on children with spastic cerebral palsy.Methods:Thirty-four children with cere- bral palsy were randomized into two groups:A)17 patients underwent soft tissue corrective surgery and B)17 patients underwent SPR.Results:In group A there was residual spasm.Mus- cular tension remained unchanged and tiptoeing disappeared:Hyperreflexia persisted.In group B spasm was eliminated.Muscular tension returned to normal.Tiptoeing and scissors gait disap- peared.Hyperreflexia diminished one month post-operatively.Both groups showed improvement in gait.More patients from group A than group B could stand steadily on one foot six months post-operatively(10 vs 8).Group B patients had better control of trunk than group A evidenced by steadier gait and easier turning of the body.Conclusion:Both soft tissue operation and SPR im- proved the gait of children with cerebral palsy,although the benefit of each operation may differ.