选择性颈段脊神经后根部分切断椎体侧块内固定配合运动疗法治疗脑性瘫引起的上肢痉挛型瘫

Selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy for treating spastic cerebral paralysis of the upper limbs caused by cerebral palsy

目的:探讨采用选择性颈段脊神经后根部分切断椎体侧块内固定配合运动疗法治疗脑性瘫引起的上肢痉挛型瘫的可行性及疗效。方法:自2004年3月至2008年4月,采用选择性颈段脊神经后根部分切断椎体侧块内固定配合运动疗法对27例上肢痉挛的脑瘫患者进行治疗,其中男19例,女8例;年龄13～21岁,平均15岁。手术方式为以AXIS8孔钛板依次植入颈椎侧块,在神经刺激仪指导下挑选阈值低神经后根的小束,将其切断并切除1.5cm。术后2周拆线后进行运动疗法训练。训练内容包括卧位姿势、翻身、坐位、爬行、跪立位及站立位、行走等练习,其中鲍巴斯(Bobath)抑制异常痉挛模式手法贯穿训练的全过程。治疗后对肌张力、运动功能(GMFM)和功能独立性(WeeFIM)进行评分。结果:27例均获得随访,时间4～16个月,平均6个月。治疗前后肌张力评分分别为3.30±0.47和1.25±0.44,GMFM评分分别为107.82±55.17和131.28±46.45,WeeFIM评分分别为57.61±25.51和87.91±22.39,治疗后患者的肌张力、运动功能和功能独立性均有所改善(P<0.01)。结论:选择性颈段脊神经后根部分切断椎体侧块内固定配合运动疗法治疗脑性瘫引起的上肢痉挛型瘫能明显降低患者的肌张力、改善运动功能,是一种安全有效的治疗方法,值得进一步推广。

Objective：To explore the feasibility and the result for the surgical treatment of spastic cerebral paralysis of the upper limbs in patients who underwent the selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy. Methods：From March 2004 to April 2008,27 patients included 19 boys and 8 girls,aging 13-21 years with an average of 15 years underwent selective cervical dorsal root cutting off part of the vertebral lateral mass fixation with exercise therapy. The AXIS 8 holes titanium plate was inserted into the lateral mass of spinous process through guidance of the nerve stimulator,choosed fasciculus of low threshold nerve dorsal root and cut off its 1.5 cm. After two weeks, training exercise therapy was done in patients. Training will include lying position,turning body,sitting position,crawling, kneeling and standing position,walking and so on. Spastic Bobath inhibiting abnormal pattern was done in the whole process of training. The muscular tension,motor function （GMFM）,functional independence （WeeFIM）were observed after treatment. Results：All patients were followed up from 4 to 16 months with an average of 6 months. Muscular tension score were respectively 3.30±0.47 and 1.25±0.44 before and after treatment;GMFM score were respectively 107.82±55.17 and 131.28±46.45; WeeFIM score were respectively 57.61±25.51 and 87.91±22.39. There was significant improvement before and after treatment （P0.01）. Conclusion：Selective cervical dorsal root cutting off part of the vertebral lateral mass fixation combined with exercise therapy was used to treat spastic cerebral paralysis of the upper limbs is safe and effective method,which can decrease muscular tension and improve motor function,which deserves more wide use.