选择性胫神经显微切断术治疗脑卒中后遗足痉挛

Selective microsurgical tibial neurotomy for treatment of the spastic foot after stroke

目的：探讨选择性胫神经显微切断术（ＳＭＴＮ）对脑卒中引起的足痉挛的矫治作用。方法： 对２４ 侧脑卒中后遗痉挛足施行ＳＭＴＮ手术。单足或单下肢痉挛４ 例， 痉挛性偏瘫以足痉挛为主者２０ 例。多数患者为以马蹄足为主要成分的混合型足痉挛畸形。手术以双极电刺激选定胫神经的痉挛责任支， 显微外科技术部分切断。结果： 术后随访７～１５ 个月， ９１％ 的马蹄足、８９％的足内翻、７５％ 的足趾强直屈曲和７５％ 的踝阵挛获完全矫正， 其余也有不同程度改善； ９０％ 的足自主运动能力和整体运动功能得到改善。无永久性手术并发症。结论： ＳＭＴＮ术通过选择性部分切断足痉挛的责任神经支， 可有效而持久地解除足痉挛、矫正畸形； 术后由于痉挛肌与其拮抗肌张力之间重新平衡及所谓“远程效应”， 整个痉挛下肢乃至全身运动功能也有不同程度的改善；

Objective:To evaluate the effect of selective microsurgical tibial neurotomy(SMTN)on spastic foot in the patients after stroke.Method:Twenty-four spastic feet underwent SMTN procedure in the present series.In most cases,the abunormal postures of the feet were mixture of various components with equinus as predominant one.In the operation the selected tibial nerve branches responsible for spasticity were partially sectioned microsurgically,following the identification with bipolar electrostimulation.Results:During the post-operative follow-up of 7-15 monthe,91% of the equinus,89% of the varus,75% of the flexion of the toes and 75% of the ankle clonus were corrected completely;the residual voluntary movements and the consequent improvement of the function in entire lower limb were observed in 90% of the cases.No permanent complication due to the surgery were recorded.Conclusions:SMTN could effectively suppress excess spasticity,correct the abnormal postures and achieve improvement in the functional status of the patients by re-establishment of tonic balance in the foot and the ‘long distance effect’.The ideal indication for SMTN should be hyperspastic disorders strictly localized to or strongly predominant in the foot.