选择性脊神经后根切断术与切断并交叉吻合术治疗脑瘫患者疗效比较

Comparison between rhizotomy and sectional cross anastomosis on posterior branch of the lumbar sacral spinal nerves in children with cerebral palsy

目的观察并比较脑瘫患者实施选择性脊神经后根切断术（SPR）和神经根部分切断并逆行交叉吻合术（SPA）的疗效。方法广东省第二人民医院和解放军第88医院全军骨科中心自1998年1月至2008年1月共手术治疗96例脑瘫患者，其中47例患者行双侧L3～S1 SPR，49例患者行SPA。术后2周、1年测定患者下肢肌张力以及运动功能改善情况。结果术后2周行2种术式的患者肌张力、运动功能的改善差异均无统计学意义（P〉0．05）；术后1年行2种术式的患者肌张力的改善差异无统计学意义（p〉0．05），但实施SPA患者运动功能改善优于SPR患者，差异有统计学意义（P〈0．05）。结论实施SPA患者运动功能的改善较好，短期内治疗效果不明显，而长期随访疗效显著。

Objective To compared the therapeutic effect of selective posterior rhizotomy （SPR） and selective posterior anastomosis （SPA） on children with cerebral palsy. Methods The postoperative follow-up was carried out in 96 patients with cerebral palsy, including 47 children performed bilateral SPR from L3 level to S1 level and 49 children performed SPA from the distal ends of L3 level to L5 level and from L4 level to S1 level, respectively. The tension and myotatic reflex of the lower limbs were estimated 2 w and 1 y after operation. Results Follow-up was conducted for 12 to 18 months on these patients. No significant difference on tension and myotatic reflex was found between patients performed SPR and that performed SPA 2 w after the operation （P〉0.05）. No significant difference of muscular tension, but statistic difference of motor function in the patients performed SPA was showed as compared with that in the patients performed SPR 1 y after the operation （P〉0.05）. Conclusion Long-term follow-up shows great motor function improvement on patients performed SPA.