肌皮、正中神经部分切断术治疗儿童肘腕痉挛型脑瘫

Slective partial neurotomy of musculocutaneous nerve or median nerve for the treatment of elbow,wrist spasticity in cerebral palsy children

目的探讨选择性上肢肌皮神经、正中神经部分切断术治疗儿童脑瘫导致的肘、腕痉挛的临床效果。方法对29例儿童脑瘫肘、腕痉挛患者,选择性肌皮神经、正中神经部分切断术,术后辅助康复治疗。分别于手术前、术后6个月、12个月行神经功能评估,观察评估治疗效果。结果所有病例随访月12～17个月,平均13个月。术后肌张力降低明显,痉挛明显缓解,肘腕关节活动范围明显改善;运动能力改善明显,总有效率89%,无明显手术并发症。结论选择性肌皮神经、正中神经部分切断术辅助康复治疗可有效的改善儿童脑瘫上肢肘腕痉挛状态,纠正肢体部分挛缩畸形,降低患儿残障程度,改善外观,提高生活质量。

Objective To investigate the effect of selective partial neurotomy of musculocutaneous nerve or median nerve for the treatment of elbow,wrist spasticity in cerebral palsy children.Methods Twenty-nine cerebral palsy children with disabling upper-limb spasticity are treated with selective partial musculocutaneous neurotomy combined median neurotomy simultaneously or respectively.Evaluation included clinical assessment of spasticity（Ashworth scale）.the range-of-motion of joints.Assessment are performed before and six months,twelve months after the operation.Results All cases are followed up about twelve months to seventeen months.Spasticity decreased obviously from 4 or 5 to 1or 2 scale in twenty-seven patients.only one case is still with 4 scale.The range-of-motion of joints increased including elbow extension and wrist extension after the surgical procedure.The motor ability improved obviously after the treatment,and the effective rate is eighty-nine percent.There was no complications permanently.Conclusion Selective peripheral neurotomy is an effective treatment for cerebral palsy children with a disabling and excessive spasticity in upper-limb.The treatment also improved the life quality of the children.