脊神经部分切断联合肌腱延长治疗痉挛型脑瘫

Selective dorsal rhizotomy combined with tendon lengthening in the treatment of the lower-extremity spasticity in cerebral palsy

目的探讨选择性脊神经后根部分切断术，同期联合肌腱延长术治疗下肢痉挛型脑瘫的方法和疗效。方法下肢痉挛型脑瘫患者23例，选择性脊神经后根部分切断，同期对伴有的下肢肌腱部分挛缩行肌腱延长术治疗。分别于手术前、术后6个月、12个月行神经功能评估。结果所有病例随访12～17个月，平均14个月。术后肌张力明显降低，痉挛及挛缩状态明显缓解，髋、膝、踝关节活动范围明显改善。术后经康复训练，运动能力改善效果明显，有效率81％，无明显手术并发症。结论选择性脊神经后根部分切断术同期联合肌腱延长术治疗下肢痉挛型脑瘫，可有效的改善痉挛状态，纠正肢体部分挛缩畸形，降低患者残障程度，提高患者的生活质量。

Objective To investigate the curative effect of selective dorsal rhizotomy combined with tendon lengthening in the treatment of lower-extremity spasticity in cerebral palsy. Methods Twenty-three cerebral palsy children with lower-extremity spasticity and contracture were treated with selective dorsal rhizotomy combined with tendon lengthening simultaneously. Evaluation including clinical assessment of spasticity （Ashworth scale） and the range-of-motion of joints assessment was performed pre-operation and 6 months, 12 months post-operation respectively. Results All cases were followed up for 12 - 17 months （mean 14 months）. Muscle tone decreased obviously. Spasticity and contraeture were alleviated significantly. The range-of-motion of joints including ankle dorsiflexion, knee extending and hip abduction was increased after operation. The motor ability was improved significantly after treatment. The effective rate was 81% and no complications occurred in all cases. Conclusion Selective dorsal rhizotomy combined with tendon lengthening in the treatment of lower-extremity in cerebral palsy can ameliorate spasticity, retrieve contracture, decrease handicap and improve quality of life.