改良选择性腰骶段脊神经后根部分切断术治疗痉挛性截瘫的初步疗效报告

The preliminary report of modified selective posterior rhizotomy of lumbosacral region for relief of spasticity of lower limbs of spasmodic paraplegia

目的探讨改良选择性腰骶段脊神经后根部分切断术治疗痉挛性截瘫的初步疗效。方法回顾分析2002年7月至2008年3月显微手术治疗的21例痉挛性截瘫患者下肢痉挛状态，全部采用改良选择性腰骶部脊神经后根部分切断术。结果平均随访26．3个月。术后即刻痉挛状态缓解率为100％，随访期间痉挛状态缓解率为91％（19／21），步态功能改善率为71％（15／21），生活质量提高率为95％（20／21）。24％（5／21）患者存在随访期间未完全缓解的下肢感觉障碍或异常，肌无力者占14％（3／21），术后发生一过性尿潴留1例（5％）。随访期间无永久性二便障碍发生。术后下肢痉挛状态不同程度复发5例（24％），其中2例（10％）回复到术前的严重程度。结论改良选择性腰骶部脊神经后根部分切断术治疗痉挛性截瘫下肢痉挛状态的短期疗效优良，但能否长期缓解痉挛或遏制住该病痉挛进行性加重的发展趋势尚有待于进一步临床观察评估。

Objective To study the preliminary effectiveness of modified selective posterior rhizotomy of lumbosacral region for relief of spasticity of lower limbs of spasmodic paraplegia. Method 21 cases of spasmodic paraplegia patients with spasticity of lower limbs were treated by modified selective posterior rhizotomy of lumbosacral region from July 2002 to March 2008. Results At follow up evaluation （mean duration：26. 3 months）, this study showed that 91% （19/21） cases experienced disappearance or notable regression of spasticity in follow- up duration. The improved motor capacities were found in 71% （15/21） cases. 95% （20/21） cases had better quality of life by follow - up studying. Postoperative complication included dysaesthesias of lower limbs（24% ,5/21 ） ,muscle weakness （14% ,3/21 ） ,transient uroschesis（5% ,1/21） ,and recurrence of spasticity（24% ,5/21）. Conclusions The preliminary study showed that modified selective posterior rbizotomy of lumbosacral region is an effective and safe microsurgical method for treatment of spasticity of lower limbs in spasmodic paraplegia patients. But its further effectiveness should be evaluated for a longer time.