选择性颈段脊神经后根部分切断术治疗脑性瘫引起的上肢痉挛型瘫

Selective Partial Cervical Posterior Rhizotomy for Treatment of Spastic Cerebral Paralysis in Upper Limbs

目的：采用双开门术式选择性颈段脊神经后根部分切断术治疗脑性瘫引起的上肢痉挛型瘫。方法：颈椎椎板两侧行上宽下窄骨槽，内板不切断，切除棘突、切断椎弓，轻轻将椎板向两侧翻开，暴露硬膜、脊髓及神经后根，选择性按比例将部分神经后根切断。缝合硬膜，将椎板回置解剖位。结果：经５个月～３年对３０例病人的术后观察，上肢痉挛解除彻底，功能得到明显改善。Ｘ光片示椎板愈合，骨折线区密度均匀，椎板结构正常，无颈椎不稳。结论：该术式创伤小，损伤轻，颈椎后部结构破坏小，椎管的完整性得到保护，痉挛解除彻底。是目前治疗脑性瘫最佳术式与方法。

Objective:Selective partial cervical posterior rhizotomy by both sides open-door laminoplasty was used to treat spastic cerebral paralysis of the upper limbs.Methods:To make a trough on both sides in the lateral part of the cervical lamina,but the trough didnt through out the lamina,remove the spinous processes,cut off the vertebral arch,lifted up the lamina to both sides gently,exposed the dura,spinal cord,nerve roots,perform partial posterior rhizotomy selectively,suture dura,reduce the lamina.Results:Thirty cases were followed up from five months to three years after operation,upper limbs spasm paralysis were solved completely,upper limbs function were improved notably,X-ray film indicated lamina healed well,with good cervical stability.Conclusion:The advantages of this operation were less tissue injury and reservation of spinal canal.It is the best method to treat cerebral paralysis.